食管癌术后肺部感染的原因

Analysis the Cause of Pulmonary Infection after Esophageal Cancer Resection

目的：探讨食管癌术后引起肺部感染的原因。方法：回顾性分析自2000年1月～2005年12月收治586例食管癌患者的临床资料,总结分析食管癌术后肺部感染的原因。结果：本组共有术后肺部感染患者46例(8%),术后因为肺部感染加重导致呼吸功能衰竭9例,其中5例最终死亡,病死率5/46。其中年龄＞60岁33例,年龄＜60岁13例(P＜0．01)。长期吸烟39例,不吸烟7例(P＜0．01)。术中呼吸道管理不善所致术后肺不张、肺部感染9例,喉返神经损伤致肺部感染4例,术后存在反流致肺部感染10例。轻度或无通气功能障碍6例,中重度慢性阻塞性通气功能障碍40例。结论：导致食管癌术后肺部感染发生的主要影响因素包括年龄、有否长期吸烟史、术前通气功能障碍、术中呼吸道管理不善、术中喉返神经的损伤以及术后胃食管反流等,应针对上述原因于食管癌围手术期加强管理。

Objective：To explore the cause of pulmonary infection after esophageal resection. Methods： We retrospectively an alyzed 586 eases with esophageal carcinoma admitted to our department from January 2000 to December 2005. The causes of pulmonary infection after esophageal carcinoma resection were summarized and analyzed. Results：Among 586 cases, pulmonary infection developed in 46 casea（8% ）; pulmonary infection aggravated to respiratory failure in 9 cases with 5 cases died. The mortality was 5/46. Of 46 cases, 33 cases were younger than 60 years old and 13 cases were older than 60 years （P〈0. 01）. 39 cases were smokers and 7 cases were non-smokers （P〈0. 01 ）. 9 cases suffered pulmonary atelectasis and pulmonary infection due to poor airway administration. 4 cases suffered pulmonary infection caused by impair to recurrent laryngeal nerve, 10 cases suffered pulmonary infection caused by gastroesophageal reflux. Among 46 cases that developed pulmonary infection, there were 6 cases with mild ventilatory defect or no ventilatory defect preoperatively and there were 40 cases with moderate to severe obstructive ventilatory defect preoperatively. Conclusion： Risk factors mainly influencing pulmonary infection after esophageal carcinoma resection included age, smoke history, preoperative ventilatory defect, intraoperative airway administration, intraoperative impair to recurrent laryngeal nerve and postoperative gastroesophageal reflux. According to above risk factors, management must be strengthened perioperatively.