食管癌合并大泡性肺气肿同期手术体会

The simultaneous surgical treatment of esophageal carcinoma complicated with bullous emphysema

目的探讨大泡性肺气肿肺功能较差的食管癌患者,同期进行食管癌根治术和肺减容术的可行性和安全性。方法我院1999年1月至2006年1月,共施行食管癌切除术1082例,其中合并大泡性肺气肿、肺功能较差的患者27例(2.5%),有选择性手术入路进行了同期手术处理。右胸三切口食管癌切除19例,右胸一切口或二切口8例;颈部吻合22例,胸内吻合5例;同时行同侧肺楔形切除21例,单个或多个肺段切除4例,上肺叶切除2例。结果无围手术期死亡,术后出现并发症18例,颈部吻合口瘘7例,肺部感染6例,肺创面漏气、气胸、皮下气肿10例,喉返神经损伤2例,咳痰无力,呼吸功能不全行气管切开呼吸机辅助呼吸6例,全部患者经积极处理无一例死亡,均恢复出院,平均住院18.6 d。结论术前精心设计手术方式,术中、术后处理得当,对大泡性肺气肿肺功能差的食管癌患者一期行肿瘤切除和肺减容手术具有可行性和安全性。

ObJective To investigate the safety and feasibility of the simultaneous operation of e- sophageal carcinoma and lung volume reduction in patients with esophageal carcinoma complicated with bullous emphysema. Methods Twenty-seven cases suffering from esophageal carcinoma complicated with bullous emphysema were treated with the simultaneous operation of esophageal carcinoma and lung volume reduction. Results No perioperative death occurred. The main postoperative complications were anastomotic leak and respiratory complications. Seven cases suffered from anastomotic leak,6 cases suffered from pneumonia and 10 cases suffered from pneumothorax, subcutaneous emphysema and air leak of the wound of lung. Conclusions The simultaneous operation of esophageal carcinoma and lung volume reduction is safe and feasible in patients with esophageal carcinoma complicated with bullous emphysema. It is very important to select meticulously the operative methods before operation and to manage appropriately the respiratory tract perioperatively.