Perforation in Gastric Cancer without Symptoms and Signs of Peritonitis

胃癌併發無顯著腹膜炎症狀之胃穿孔

吳炳燁(Ping-Yeh Wu) ； 蔡孟叡(Meng-Jui Tsai) ； 陳巧芸(Chiao-Yun Chen) ； 王鐘貴(Chung-Kwe Wang)

《北市醫學雜誌》 3卷6期 (2006/06) Pp. 642-646

https://doi.org/10.6200/TCMJ.2006.3.6.12

摘要

胃癌破裂是一個少見的併發症。我們報告一個80歲男性病人，主訴為吞嚥困難及進食後的嘔吐，但腹部無劇烈疼痛或是壓痛之症狀。胃鏡下發現胃癌之後，意外於電腦斷層檢查發現胃癌破裂。病患接受緊急胃亞全切除術及淋巴廓清，術中發現係胃癌侵犯至橫結腸且於胃小彎處有一腫瘤破孔，且腹膜將破孔完全包覆。大約有兩千西西的腹水被引流出來。腹水之細胞學檢查陰性且病理切片顯示並無淋巴結侵犯。術後分期為ⅢA期(T4NOMO)。查閱文獻顯示，對於胃癌破裂患者，術後分期較早期、能夠做到廣泛性的胃切除術及淋巴廓清可以達到較好的預後及延長存活時間。此案例由於失智無法明確表達自己的不適，並且由於腹膜包覆腫瘤破孔使得臨床無腹膜炎症狀，對於此類病患，電腦斷層可以提供良好的術前診斷。

關鍵字

胃癌 ； 胃穿孔 ； 腹膜炎

並列摘要

Perforation of gastric cancer is a rare complication. We reported a male patient who did not have symptom and sign of peritonitis but gastric cancer perforation was found by staging computed tomography. This patient underwent an emergency laparotomy and D1 subtotal gastrectomy. Gastric cancer invasion to mesocolon and one perforated hole at lesser curvature of the stomach were noted during surgery. The perforation was sealed-off by omentum covering. Pathologic examination revealed poorly differentiated adenocarcinoma without regional lymph node involvement (stage ⅢA, T4NOMO). Previous studies showed that early diagnosis, radical gastrectomy and extensive lymph node dissection can improve outcome and survival rate of such patient. CT examination may be indicated in patient who can not present his discomfort precisely.

並列關鍵字

gastric cancer ； gastric perforation ； peritonitis