老年食管癌、贲门癌根治术的围手术期处理(附580例体会)

Clinical Analysis of Perioperative Treatment for Esophageal and Gastric Cardia Carcinoma in 580 Aged Cases

目的总结老年食管癌、贲门癌患者围手术期处理经验。方法回顾性分析老年食管癌、贲门癌580例手术治疗情况,平均年龄68(60～79)岁。术中予双腔气管插管、静脉复合麻醉,经左后外侧开胸行食管、贲门癌根治性切除术;围手术期予营养支持、呼吸道管理,并及时处理呼吸衰竭等并发症。结果术后发生并发症152例,其中呼吸道并发症118例(77.6%),死亡12例,7例死于呼吸衰竭,2例心脏猝死。360例平均随访4(1～7)年,3年、5年生存率分别为48.7%和36.8%。结论老年食管癌、贲门癌围手术期予营养支持、严格的呼吸道管理及术后正确处理呼吸道并发症是手术治疗成功的关键。

Objective To review the perioperative treatment of radical surgery for esophageal and gastric cardia cancer in old age（ 〉60 years）. Method 580 aged cases of esophageal and gastric cardia carcinoma underwent radical surgery were retrospectively reviewed. Agverage age was 68. Under general anesthesia with bilateral tracheal intubation, the radical resection for the carcinoma of esophagocardia carcinoma was performed via left posterolateral incision. Postoperative treatment included nutritional supplement, respiratory management and timely intervention for respiratory dysfunction. Result 152 cases experienced complications, including respiratory complications in 118 cases. 12 deaths occurred including respiratory failure in 7 cases,cardiac arrest in 2 cases. According to 1 to 7 years follow-up, the 3-, 5-year survival rate were 48.7% and 36.8%, respectively. Conclusion With regard to the radical surgery for esophagocardia carcinoma in old aged patients, the perioperative nutritional support, satisfied respiratory management and properly treatment of respiratory complication are critical in improving the therapeutic effect.