重症高龄高危肺癌病人的围术期处理

目的　总结重症、高龄、高危肺癌病人的围手术期处理经验。方法　 1992年 5月至 2 0 0 2年 12月手术治疗肺癌病人 6 37例 ,其中符合重症、高龄、高危者 118例。术前测定右心室射血分数(RVEF) ,按RVEF值分成 <0 45及≥ 0 45两组。结果　全组 116例治愈 ,住院死亡 2例 ,发生并发症 6 4例。结论　重症、高龄、高危肺癌病人并发症的发病率随RVEF的降低而升高 ,强调重视右心功能与并发症的关系。术后强化呼吸道管理及合理使用呼吸机能为手术成功创造有利条件。     

高龄高危食管癌贲门癌患者外科治疗体会

目的 :探讨高龄高危食管癌贲门癌患者外科治疗的临床效果。方法 :对 3 6例高龄高危食管癌贲门癌患者在全麻下行食管肿瘤、贲门肿瘤切除术 ,并对围手术期心肺功能不全者进行处理。结果 :根治性切除 2 6例 ,姑息性切除 10例 ,术后并发症 14例 ,围手术期死亡 3例 (8.3 % )。结论 :对高龄高危食管癌贲门癌的外科治疗重点应放在围手术期的管理上。     

大肠癌术后围手术期死亡11例原因分析

1991年始手术治疗大肠癌612例，术后围手术期死亡11例，死亡率1.8%，手术期死亡与肿瘤、手术、患者等因素有密切关系，提出早期发现梗阻性大肠癌；合理选择高龄高危晚期大肠癌的手术方式、提高手术质量；加强围手术期的处理以降低死亡率。     

高龄食管癌贲门癌患者术后呼吸衰竭的防治

高龄(≥70岁)食管癌患者围手术期治疗的关键在于呼吸道管理。我们自1987年8月至1994年8月间,外科治疗食管癌1864例,其中高龄患者260例,由于严格的围手术期呼吸道管理和正确处理呼吸衰竭等并发症,治疗结果满意,特别是术后纤维支气管镜检查吸痰、抗菌药液支气骨灌洗、气管切开、呼吸机辅助呼吸及胃肠外营养支持等,为高龄患者手术创造了条件,提高了临床治愈率和生存率。     

高龄大肠癌外科治疗158例分析

目的 探讨高龄大肠癌围手术期处理的有关问题。方法 回顾性分析了１９９１年和１０月至１９９７年５月１５８例７０岁以上大肠癌病人的外科处理。结果 根治性切除１１３例，切除率７１．５％，姑息性切除１５例，Ｈａｒｔｍａｎｎ术９例，结肠造口１８例，短路３例，术后并发症４３例，围手术期死亡１２例，病死率７．６％。结论 对高龄大肠癌病人除加强围期营养支持外，充分的术前准备，适当的手术时机与手术方式的选择，完善的     

高龄高危病人髋关节置换的围手术期处理

[目的]探讨高龄高危病人髋关节置换围手术期的安全性。[方法]48例80岁以上的高龄病人行髋关节置换手术，ASA评分：Ⅰ级22例、Ⅱ级13例、Ⅲ级11例、Ⅳ级2例。所有病例术前详细检查，针对其基础病积极内科治疗，把握手术时机，术中注意手术体位、加强麻醉监测，术后积极康复治疗。[结果]术后随访12～40个月（平均26个月），Harris评分70～94分，平均88分。无致死性并发症发生。[结论]对高龄高危病人的围手术期处理医生要充分重视，及时取得病人及家属的理解，加强术前、术中、术后各个环节的操作，近期随访效果满意。     

胸部肿瘤围手术期心律失常的原因分析及护理

开胸手术围手术期心血管并发症十分常见，尤以心律失常居多。围术期密切监测心电图的变化，以便及时发现心律失常十分重要。我院2001年1月～2004年11月对196例胸部肿瘤围术期病人进行连续心电监护，发现心律失常66例，发生率33％。我们对这些病例进行观察分析如下：     

高龄开胸患者围术期的呼吸道管理

目的探讨高龄患者开胸手术后围术期呼吸道管理与术后康复的关系。方法针对高龄患者开胸术后呼吸功能减退、咳嗽排痰无力等特点,对108例高龄开胸病人围术期加强呼吸道管理:术前加强呼吸功能训练、术前戒烟及术后采取正确的体位,湿化呼吸道,有效咳嗽、咳痰,密切观察病情变化等措施。结果除2例病人术后给予呼吸机辅助呼吸3～12d外,其余病人全部顺利康复,全组病人无死亡。结论加强高龄病人围术期的呼吸道管理,可有效地减少术后并发症,保障病人顺利康复。     

重症高龄高危食管癌患者围手术期护理

1986年1月至1997年12月，我科收治重症高龄高危食管癌患者139例，由于加强围手术期的护理，取得了良好的效果，总结如下。1！院床资料1．1诊断标准①重症：食管癌纵轴长度＞10cm者（根据X线造影和术中测量判定）；②高龄：年龄＞70岁者；③高危：术前重度呼吸功能不全，最大通气量（MVV）＜50％者［‘］1．2一般资料本组139例患者符合上述诊断标准2项和2项以上，男110例，女29例，年龄70～82岁。食管癌86例，贲门癌53例。术前有吸烟史者85例，最长50年。食管癌合并慢性支气管炎55例，贲门癌合并慢性支气管炎25例，其中35例有不同程度的肺…     

高龄重症急性胆囊炎诊治体会

目的探讨高龄重症急性胆囊炎患者治疗方法。方法对我院1995～2004年经手术治疗的43例70岁以上高龄重症急性胆囊炎的临床资料进行回顾性分析。结果死亡8例,病死率18.60%,手术并发症发生率27.90%。结论并存病是引起死亡及出现术后并发症的高危因素,年龄并不是手术禁忌,早期手术,加强围手术期处理,合理选用手术方式是关键。     

老年食管癌、贲门癌根治术的围手术期处理(附580例体会)

目的总结老年食管癌、贲门癌患者围手术期处理经验。方法回顾性分析老年食管癌、贲门癌580例手术治疗情况,平均年龄68(60～79)岁。术中予双腔气管插管、静脉复合麻醉,经左后外侧开胸行食管、贲门癌根治性切除术;围手术期予营养支持、呼吸道管理,并及时处理呼吸衰竭等并发症。结果术后发生并发症152例,其中呼吸道并发症118例(77.6%),死亡12例,7例死于呼吸衰竭,2例心脏猝死。360例平均随访4(1～7)年,3年、5年生存率分别为48.7%和36.8%。结论老年食管癌、贲门癌围手术期予营养支持、严格的呼吸道管理及术后正确处理呼吸道并发症是手术治疗成功的关键。     

超高龄病人腹部外科手术的围术期处理

目的 探讨８０岁以上超高龄病人外科手术的围手术期处理及手术指征。方法 回顾性分析２５例８０岁以上超高龄病人腹部外科手术情况。结果 胆道手术（８例）,胃癌、贲门癌手术（１３例）,食管扒脱术（１例）,肠道手术（３例）。手术治愈２４例（９６％）,术后死亡１例（４％）。结论 超高龄病人并存病多,术后并发症多,必须强化围手术期处理,尽可能做择期手术,减少急诊手术,重视白蛋白的补充,增强组织的修复愈合。     

Postoperative pulmonary complication and surgical treatment of esophageal cancer in aged patients--evaluation of preoperative risk factors and postoperative management

Because of the recent improvement in surgical technique and perioperative management, surgical treatment for esophageal cancer has become more extensive and thus even aged poor-risk patients can be operated on. However, transthoracic esophagectomy is still associated with a high rate of postoperative pulmonary complications. We analysed the preoperative findings and postoperative treatment in aged patients. During the decade starting from 1980, 151 patients with esophageal cancer were admitted to our clinic, there were 44 aged patients over 70 years. They were examined for preoperative risk factors associated with multiple organ functions. Our special attention was paid to postoperative pulmonary complications and hemodynamics that were monitored using the Swan-Ganz catheter. In the aged patients, there were highly abnormal finding in preoperative examinations, especially in cardiac, pulmonary and renal functions. Moreover, their cardiac index levels were lower and pulmonary vascular resistance levels were higher than those of the younger group. Postoperative pulmonary complications were induced frequently in the poor-risk patients who underwent transthoracic esophagectomy. However, the patients who were received infusion of dopamine and dobutamine were able to keep hemodynamic balance in the early postoperative period. Most patients with esophageal cancer are relatively old and have often multiorgan dysfunction. Transhiatal esophagectomy is a safe operation that is suitable for the treatment of aged poor-risk patients who can not tolerate thoracotomy. Choice of a surgical procedure for them should be carefully determined according to the systemic preoperative assessment of risk factors. Postoperative fluid therapy and respiratory management should be performed more strictly in the aged patient.     

42例老年性食管癌手术治疗分析

本文报告４２例老年食管癌病人的外科治疗结果，男性３５例，女性７例，年龄６０～８０岁，平均６５．７岁。术前２３例病人有心电图异常，９例有慢性肺疾患，１２例有其它的伴存疾病。本文对老年食管癌的特点、术前准备，围手术期的监护和处理进行了讨论。     

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目的探讨高龄结、直肠癌病人并存病的围手术期处理。方法回顾性分析1996年1月至2000年7月间收治65例70岁以上有并存病的结、直肠癌病人的外科治疗？结果并存心脏病40例，高血压17例，糖尿病13例，呼吸系统疾病13例，贫血26例，低蛋白血症41例。术后并发症有肠瘘2例，伤口裂开2例、伤口感染8例，肺部感染3例，心功能不全1例。围手术期死亡2例。结论虽然并存病增加了手术风险，但术前全面了解病情，加强并存病的围手术期处理可大大提高手术成功率，降低手术死亡率和并发症发生率。     

Esophageal resection by cervico-abdominal approach without thoracotomy

The authors report their experience with transhiatal esophageal resection accumulated during the period between January 1978 and March 1990. Indications for the procedure included cancer of the gastric cardia (26.3%), cancer of the hypopharynx (3.8%), cancer of the esophagus (59.2%), and benign esophageal disease (9.8%). Esophageal substitution was performed using a tubulized stomach (63.6%), ileo-cecocoloplasty (28.5%), left colon (7.6%), and jejunum (0.3%). The majority of patients with neoplastic disease were found to be in an advanced stage (67.3% of esophageal cancer patients and 69.7% of cancer of the cardia patients with stage III disease). The mean intra-operative volume of blood transfused varied between 533 and 1,220 ml. Sixteen patients required hospitalization in the intensive care unit. The mean length of post-operative hospitalization varied between 16.8 and 20.6 days. Operative complications included hemorrhage (0.3%) and tracheal injury (0.6%). Operative (30 day) mortality was 5.8%. Causes of death included respiratory insufficiency (35.2%), pulmonary sepsis (23.5%), abdominal sepsis (17.8%), and others (undefined, 23.5%). The 5 year survival was 48.5% for cancer of the gastric cardia, 57.1% for cancer of the hypopharynx and 11.8% for esophageal cancer.     

快速康复外科理念在食管癌治疗中的应用

目的探讨快速康复外科理念在食管癌患者围手术期的应用及对患者的临床结局的影响。方法收集2011年1-6月间南京医科大学附属淮安第一医院胸外科接受食管癌根治术的食管鳞癌患者117例,其中4-6月63例（研究组）,围手术期采用快速康复外科理念进行处理：1～3月接受手术54例（对照组）,围手术期按常规处理。结果研究组术后排气时间、术后拔除胸腔引流管时间、术后住院时间及住院总费用均显著低于对照组（P〈O．05）：手术时间两组差异无统计学意义（P〉0．05）。研究组和对照组总并发症的发生率分别为7．9％（5／63）和24．1％（13／54）,差异有统计学意义（P〈0．05）。结论食管癌患者围手术期应用快速康复外科理念,可促进术后肠功能恢复．减少术后并发症发生率．从而改善患者的临床结局．     

Management of panesophageal cancer by blunt resection without thoracotomy and reconstruction with stomach.

Encouraged by their experience since 1978 with blunt esophagectomy and gastric reconstruction in the management of pharyngolaryngeal malignancy, the authors have extended their use of this technique to the management of thoracic esophageal cancer. A study of 43 blunt esophageal resections is presented; 23 were performed in the management of pharyngolaryngeal cancer, and 20 were performed (22 attempted) for the resection of intrathoracic esophageal cancer. In the first group, two deaths occurred secondary to liver failure in cirrhotic patients with moist ascites. One death occurred due to anastomotic leak in the neck of a patient with laryngeal cancer treated with extended mediastinal dissection and tracheal resection for surgical and radiation failure. Two tracheal injuries occurred; one could be managed through the neck, and one required thoractomy for repair. In the 20 resections performed for intrathoracic cancer, there were no deaths, no tracheal injuries, and one chest was explored for bleeding in the splenic bed, which decompressed itself into the right chest. The overall mortality was 7.5%. The evaluation emphasizes: The applicability of this technique for the management of esophageal problems at all levels. The safety of the technique, particularly in the typical population with advanced aged and severe underlying medical illness. Good functional results with palliation and/or cure. The benefit of intact mediastinal pleura in avoiding certain thoracic complications. The authors conclude that blunt esophagectomy is a safe resection procedure with limited morbidity and mortality, and that gastric reconstruction is reliable and affords excellent functional results. They are encouraged to continue management of panesophageal cancer with this technique.     

Indications for thoracic radiography in the preoperative evaluation for elective surgery

OBJECTIVES: To establish a protocol for ordering chest x-ray films for screening before elective surgery. To study the prevalence of anomalies detected in routinely-ordered chest x-rays, their influence on management of anesthesia and surgery and on the prevention of perioperative complications. MATERIAL AND METHODS: A prospective study of 413 patients undergoing elective surgery over a period of two years. Anomalies detected in chest films were classified as significant or not significant and then as expected or unexpected in function of agreement between the patient's medical history and the image. RESULTS: A preoperative chest x-ray was obtained for 99.5% of the patients and anomalies were detected in 28.1%, of which 49.1% were significant. The prevalence of anomalies was higher among men over 60 years of age, smokers, those with cardiac or respiratory disease, and those who were classified ASA III-IV. In 6.9% of the cases, the anomalous findings were unexpected based on the patient's history. Findings led to preoperative changes in management in 0.5% of the cases; no delays or cancellations occurred. The frequencies of intraoperative and postoperative complications were 7.9% and 24.6%, respectively. CONCLUSIONS: A preoperative chest x-ray should be ordered only for patients over 60 years of age, smokers of 10 cigarettes/day or more, those with heart or respiratory disease, those who have had contact with tuberculosis and who have not had any other chest x-ray taken within the past year.     

Ivor-Lewis手术在老年中下段食管癌患者中的应用

目的探讨Ivor-Lewis手术治疗老年中下段食管癌患者的安全性。方法前瞻性入组2009年6月至2010年6月天津医科大学肿瘤医院老年（60岁以上）中下段食管癌患者232例,按随机数字表法分为Ivor-Lewis手术组（116例,取右胸后外侧及上腹正中切口）和Sweet手术组（116例,取左胸后外侧切口）,比较两组术中...