管状胃在高龄食管癌和贲门癌根治术中的应用

目的：总结70岁以上高龄食管癌、贲门癌根治手术中应用管状胃代食管的手术操作方法,分析术后肺部并发症的发生及术后生存的情况。方法回顾分析30例70岁以上高龄食管癌和贲门癌患者临床资料,术中应用管状胃代替食管,统计分析术后发生的肺部并发症和随访资料。结果术中保留胃右动脉及分支的管状胃制作成功,23例术后无明显肺部并发症发生,4例出现明显肺部感染,积极治疗后康复出院；2例术后气管切开,呼吸机辅助呼吸,1周后顺利脱离呼吸机；1例较长时间呼吸机辅助呼吸,出现吻合口瘘,最终死亡。术后随访21例,无明显反流性食管炎发生,术后1月后生活基本自理。1、3年生存率分别为42．8%(9/21)和19．0%(4/21)。结论应用管状胃代食管,对高龄食管癌和贲门癌患者,可以有效预防吻合口瘘,减少胸腔胃对心肺功能的影响,减少反流性食管炎的发生,提高患者术后生存质量。

Application of gastric tube for radical operation with esophageal and cardiac carcinoma

Objective To summarize operative procedure, postoperative lung complications and postoperative survival in gastric tube for radical operation with esophageal and cardiac carcinoma in elder patients. Methods The clinical data of 30 patients over 70 years old with esophageal and cardiac carcinoma who were operated in our hospital from July 2010 to September 2014 were analyzed. The data included gastric tube to take the place of esophageal, postoperative lung complications and postoperative follow up. Results The gastric tube which reserved the right gastric artery and branches was made successfully in operation. Among the patients, 23 cases without postoperative pulmo-nary complications occurred obviously in postoperative, 4 cases occurred lung infection and mild hypoxemia, 2 cases achieved full recovery with the help of breathing machine help to breathe in a week after operation, 1 case was dead in case of breathing machine help to breathe for a long time after operation, which occurred anastomotic fistula at the same time. 21 cases were follow-up postoperatively. The quality of life was improved significantly for a month after operation. The one and three year survival rate was 42. 8%(9/21)and 19. 0%(4/21)respective-ly. Conclusion The gastric tube is effective in preventing anastomotic fistula, reducing the chest gastric effects on cardiopulmonary func-tion, decreasing reflux esophagitis, improving the quality of patients with postoperative survival for esophageal and cardiac carcinoma over 70 years old.