老年人食管贲门癌的外科治疗

Surgical treatment of the aged patients with carcinoma of the esophagus and cardia of the stomach.

目的总结外科治疗老年人食管贲门癌的经验. 方法回顾性分析91例70岁以上食管贲门癌患者手术治疗临床资料,全组平均年龄76.1岁,最高年龄达92岁. 病变长度3cm以内33例,3～6cm 43例,6cm以上15例.伴随有心肺脏器疾病56例.TNM分期属I期22例,II期46例,III期23例. 结果 91例中87例将病变切除,手术切除率为95.60%;鳞癌79例,腺癌12例.术后发生并发症25例,主要为肺部感染13例,呼吸衰竭2例,心律失常11例,心动过缓3例,心衰4例,死于呼吸衰竭1例. 结论 70岁以上老年人食管贲门癌,只要全身情况能够耐受,就应该积极行食管贲门癌切除手术.围术期积极防治循环呼吸系统并发症是手术成功的重要保证.

Objective To summarize the experience of surgical treatment of the aged patients with carcinoma of the esophagus and cardia of the stomach. Methods Clinical data of 91 patients, over the age of 70, with carcinoma of esophagus and cardia, whose median age was 76.1（70 - 92 ） , were analyzed retrospectively. The length of the tumors was less than 3cm in 33 patients, 3 -6cm in 43 patients, and above 6cm in 15 patients. Cardiac and/or pulmonic diseases were accompanied in 56 patients, 22 of them were at stage Ⅰ of TNM, 46 of them were at stage Ⅱ and 23 of them at Stage Ⅲ. Results 87 cases were resected the tumors in this group, the resectable rate is 95.60%. Pathological examination postoperatively demonstrated that 79 cases were squamous carcinoma and 12 adenocarcinoma. Postoperative complications occurred in 25 patients： infestation of lung 13 cases , respiratory failure 2 cases, arrhythmia 11 cases, bradycardia 3cases, cardiac failure 4cases, 1 patient died of respiratory failure. Conclusion Patients cver 70 - year - old with carcinoma of esophagus and cardia must be resected the tumors by operation when they have the power to resist operations. The important guarantee of successful operation is to prevent and cure complications of peri - operation in the circulatory and respiratory systems.