高龄食管癌患者围手术期治疗体会

Surgical Treatment for Esophagus Cancer in Aged Patients

目的探讨高龄食管癌患者外科手术的疗效及围手术期处理经验。方法回顾性分析33例高龄食管癌患者的临床资料,平均年龄75.1（71-89）岁。伴有慢性支气管炎和（/或）肺气肿11例;轻-中度肺功能障碍9例;冠心病8例;心律失常2例;高血压12例;糖尿病4例。病变长度平均4.0（3-8）cm。均采用经左后外侧切口进胸,行食管癌切除和食管残端-胃吻合术。结果33例患者中,有31例食管癌顺利切除,手术切除率为93.9%。术后发生肺部感染6例（其中伴呼吸衰竭2例）,心力衰竭2例,吻合口瘘1例。均获随访,平均时间1.0年（3个月-4年）。术后1年生存率为84.8%（28/33）。死亡5例,除1例围手术期死亡外,2例死于肿瘤复发转移,死于急性心肌梗塞和肺部感染各1例。结论高龄食管癌患者,只要全身情况能够耐受手术,应在充分术前准备基础上,积极行食管癌切除手术。围手术期积极处理心肺系统并发症是手术成功的重要保证。

Objective To summarize the experience of surgical treatment for esophagus cancer in aged patients. Methods Clinical data of 33 patients with esophagus cancer were analyzed retrospectively. The mean age was 75. 1 （ 71 - 89 ） years. 33 cases had other diseases, in which 11 of chronic bronchitis and （/or） emphysema, 9 of mild to midrange pulmonary disfunction, 8 of coronary artery disease, 2 of arhythmia, 12 of high blood pressure, and 4 of diabetes. The length of the tumors was 4.0 （3 - 8 ） cm averagely. Left posterolateral incision was used for cancer removal and esophagogastroanastomosis in all patients. Results The tumors of 31 cases were resected in this group, the resectable rate is 93.9%. The postoperative complications occurred in 9 patients, including 6 of pulmonary infection, 2 of heart failure, and 1 of stoma fistula. 5 cases died, in which one died peri-operatively, 2 from tumor relapse, 1 from heart infarction, and 1 from pulmonary infection. The 1-year survival for this group was 84.8% （23/33）. Conclusions The over 70-year-old patients with esophagus cancer should be treated by operation if they can tolerate the trauma. It is the key point to control cardiac and pulmonary complications for the success of the operation.