高龄食管癌贲门癌的外科治疗

目的探讨高龄食管癌贲门癌患者手术适应证的选择及围手术期的处理.方法回顾性分析36例65岁以上高龄食管癌贲门癌手术病例的临床资料.结果36例中,手术切除35例,切除率为97.2%.术后并发症25例(69.4%),其中肺部并发症19例(76%),心血管系统并发症15例(60%),全组无死亡.术前合并有肺部疾病12例中术后发生肺部并发症10例(83.3%),手术操作时间≥4 h的17例中术后发生肺部并发症14例(82.4%)、发生心血管系统并发症12例(70.6%),术后有肺部并发症的19例中发生心血管系统并发症13例(68.4%),与相应对照组比较,经x2检验两者差异有显著性(P＜0.05或P＜0.01).术后生存率随访结果与其他年龄组相仿.结论高龄食管癌贲门癌患者术前应积极准备,严格掌握手术适应证,术中尽量缩短时间,并进行妥善有效的围手术期的综合处理.

Surgical treatment of aged esophageal and cardiac cancer

Aim To investigate the indication of surgical treatment on aged patients suffered from both esophageal and cardiac cancers and to evaluate the management during their peri operation period.Methods 36 cases of esophageal and cardiac cancer patients over 65 years old were collected. The clinlical data were analysed and reviewed. Results Among the 36 cases, tumours were removed by surgical operation in 35 cases(97 2%), No one died in the whole group. After the operation, 25 complications were found(69 4%). Among these complications, 19 cases were complicated with pulmonary diseases(76%) and 15 cases with cardiovascular diseases(60%). Before the operation 12 cases suffered from pulmonary diseases, and after the operation 10 of them showed pulmonary complications(83 3%). 17 cases were operated for more than 4 hours. 14 cases of them were complicated with pulmonary diseases(82 4%), and 12 cases of them were complicated with cardiovascular diseases(70 6%). Among the 18 cases of pulmonary complications, 13 cases also were complicated with cardiovascular diseases. Compared with the correspondent groups, the differences were significant( P <0 05 or P<0 01). The survival rate after the operation analyzed by the follow up examination was similar to that in the group of younger patients.Couclusions According to the aged patients suffered from both esophageal and cardiac cancers, enough preparation should be taken before surgery. Indication of the surgical treatment must be strictly restricted. Shortening the span of operation will be helpful. Careful and effective peri operation treatment must be carried out.