重症高龄高危胸部肿瘤患者外科治疗经验

重症高龄高危胸部肿瘤患者开胸根治术后处理的关键在于围手术期呼吸道管理。作者总结１９８４年５月至１９９５年１１月外科治疗胸部肿瘤１６６１例中，符合重症高龄高危者１９８例，由于围手术期强化呼吸道管理和正确处理并发症，收到满意结果。作者强调围手术期强化呼吸道管理的三个环节七个步骤，特别是环甲膜穿刺硬膜外导管留置定时注药刺激咳嗽排痰，气管镜检查吸痰抗菌药液支气管灌洗，酌情合理使用呼吸机等，均为成功扩大手术切除适应范围安全度过手术关创造十分有利的条件。

Perioperative management of open chest surgery for cancer patients in advanced stage,in aged and with respiratory insufficiency

For patients with chest cancer who are in advanced stage,aged, or/and with respiratory insufficiency,the key to the success of open chest surgery is intensive management of the respiratory tract and proper treatment of complications in perioperative period.From May 1984 to November 1995,1661 patients with esophageal and lung cancer underwent thoracotomy in our hospital. 198 of the 1661 patients fit in with the standards of advanced,aged or respiratory insufficiency.The patients were aged over 70 years, with the length of esophageal cancer over 10cm and,the MVV less than 50% (least 24 3%). The results the patients were satisfactory because a series of the effective measures of perioperative management were tahen. They incladed thyrocrico puncture and use of a fine tube through which drugs were injected to irritate cough sputum out; examination and suction with bronchofiberoscope; tracheo bronchial lavage through bronchofiberoscope with antibiotics solution; and tracheotomy using ventilator appropriately.Perioperrative intensive management is very important for extending operation indication and tiding over critical period.