70岁以上高龄食管癌患者手术的围手术期处理

目的 探讨70岁以上高龄食管癌患者手术的围手术期处理方法及注意事项.方法 本组手术治疗的70岁以上高龄食管癌患者40例.其中合并慢性支气管炎、肺气肿23例,肺功能轻度受损18例,高血压15例,冠状动脉硬化10例,EKG异常17例,以往有十二指肠溃疡3例,糖尿病9例,心肌梗死1例.手术切除39例,颈胸两切口2例,弓上吻合13例,弓下吻合24例,全组均用胃代食管手术.结果 本组术后并发症16例,占全组的40.0%,呼吸系统并发症10例,心血管系统并发症3例,吻合口瘘2例及胃排空障碍1例.本组死亡1例,死亡原因,急性呼吸衰竭.结论 术前对合并症如呼吸,循环疾病,糖尿病的患者进行支持治疗,有效的改善心肺功能,控制血糖,预防感染,使患者术前调整到最佳状态.术后要加强抗感染,保护心肌,加强循环、血糖和水电解质监测,并及时处理.有急性呼吸衰竭先兆,立即行预防性气管切开吸痰和使用呼吸机辅助呼吸.经过上述处理可有效地防止高龄食管癌手术患者的术后并发症,顺利度过围手术期,取得满意的手术疗效.

The perioperative treatment of esophagus cancer in elderly persons above 70

Objective To analyze the perioperative treatment of elderly esophagus cancer operation(age>70).Methods Between April 1995 and April 2006,40 elderly patients(age>70)with carcinoma of esophagus were treated with surgical operation.Among these,23 cases had the chronic obstructive emphysema,18 cases the lung function damage,15 cases the hypertension,10 cases the coronary sclerosis,17 cases the ECG abnormality,3 cases the duodenal ulcer,9 cases the diabetes and 1 case the miocardial infarction.39 cases underwent complete exairesis.2 cases were given operation with both incisal opeings of neck and chest,13 cases were performed operation of anastomosis above the aortic arch,and 24 cases were performed below the aortic arch.In 39 patients,the reconstrution was applied.Results There were 16 cases of postoperative complications in the operation group(40.0%).Among these,respiratory system complication occurred in 10 cases,cardiovascular system complication in 3 cases,the fistula in stoma in 2 cases and gastric emptying disability in 1 case.1 patient died with acute respiratory failure.Conclusion Before operation,patients should be adjusted to the best condition.After the operation patients must be prevented from infection,their cardiac muscle be protected and the circulatory monitoring be strengthened.If patients have omen of acute respiratory failure,we must conduct tracheotomy to draw off sputum and use the breathing machine immediately.In this way,we can prevent postoperative complications.