老年重症高危食管癌患者围手术期处理经验（附56例报告）

目的:探讨老年重症、高危食管癌根治患者的围手术期处理.方法:总结1989年6月～1997年5月手术治疗612例食管癌中老年重症高危患者56例,分析治疗过程及并发症的处理.结果:强化围术期心功能保护和呼吸道管理,取得了满意的治疗效果,全组治愈.结论:应强调加强围术期管理,特别是扩冠治疗改善心肌缺血,增加心功能储备;在呼吸道管理中,可以采取环甲膜穿刺注药刺激咳嗽排痰,气管镜吸痰并支气管灌洗,合理使用呼吸机及积极抗感染治疗,为成功扩大手术适应症,安全度过手术关创造了有利的条件.

Experience of perioperative management for excision of esophageal carcinoma in aged,in advanced stage and with cardiac or respiratory insufficiency

Purpose: To study surgical treatment experience for geriatric patients with esophageal carcinoma who were the aged,in advanced stage,and with cardiac or respiratory insufficiency. Methods: From June 1989 to May 1997,612 patients with esophageal carcinoma underwent thoracotomy in our hospital. 56 of them fit in with the standards:over 60 years of age,in ad-vanced stage and with cardiac or respiratory insufficiency, protection of the patients's cardiac function and management of the res-piratory tract were analysed in perioperative period. Results:The complication occurred in 23 cases with an incidence of 41%. There were no post-operative mortality in this series. Conclusions:For these patients,the key to the success of open-chest surgery was intensive perioperative management. These included: improve myocardial ischemia and strong cardiac function by dilating coronary artery drugs ;inject drugs by throcrico-puncture to irritate coughing sputum up;lavage tracheo-bronch through broncho-fiberoscope with antibiotics solution ; use ventilator appropriately and treat post-poeriative infection. These measurements may be very important for extending operative indication and tiding over critical period.