高龄食管癌贲门癌患者术后主要并发症的原因分析

回顾性分析103例70岁以上食管癌贲门癌患者临床资料，结果发现术后主要并发症为吻合口瘘及肺部并发症，吻合口瘘的发生与手术方式相关。三切口手术及食管拔脱左颈吻合术吻合口瘘的发生率显著高于其他手术方式（P＜0．01）。肺部并发症的发生与术前肺功能及手术方式均密切相关，术前肺功能差者即使行不开胸的食管拔脱术，肺部并发症的发生率仍高达60％；术前肺功能正常患者，三切口术及二切口右胸顶吻合术肺部并发症发生率亦高达39％。显著高于其他手术组（P＜0．01）。故对老年食管癌贲门癌患者应尽量避免三切口及二切口右胸顶吻合术，且加强围期呼吸道管理至关重要。

Preoperative risk factors and different operative methods on postoperative complications in elderly patients with esophageal cardia cancer

A retrospective review of 103 consecutive patients aged 70 years or above underwent radical tumor resection was conducted to define the relationship between preoperative risk factors,operative method selection and postoperative complications.The main postoperative complications were anastomotic leak and respiratory complications.The development of anastomotic leak was closely related with the selected method for operative treatment.The incidence of anastomotic leak in three incisional approach and transhiatal approach was as high as 40%,which was significantly higher than other approachs ( P < 0.01). The development of pulmonary complications were also closely linked to preoperative pulmonary function and the operative method.Those who had poor pulmonary function,the incidence of pulmonary complications was still 60%,eventhough they underwent transhiatal approach without thoracotomy.For those who underwent three incisional or two incisional operation and had normal pulmonary function,the incidence of pulmonary complications was 39%,also much higher than other approachs( P <0.01). We suggest that three incisional and two incisional approach should not be selected for the operative treatment of esophageal cancer in elderly patients.It is very important to enhance the management of respiratory tract in the patients' periopertive period.