70岁以上食管癌和贲门癌患者的开胸手术分析

Analysis of key factors for the successful chest operation in elderly patients with esophageal cancer or carcinoma of gastric cardia.

目的探讨高龄食管癌和贲门癌患者的外科手术选择及围手术期处理方法。方法回顾性分析1088例食管癌和贲门癌患者的临床资料，分为70岁以下（41～69岁）、70～74岁、75～79岁、80岁以上（80～90岁）4组。统计4组患者术后并发症、住院时间及预后，并对手术选择和围手术期治疗措施进行分析。结果70岁以上食管癌和贲门癌患者术后肺部感染、心律失常、精神症状和切口不愈的发生率明显上升，术后住院时间明显延长；80岁以上的高龄患者术后肺部感染发生率和术后住院时间较其他年龄段明显上升。全组痊愈1084例，死亡4例。结论在高龄食管癌和贲门癌患者中，了解开胸术后并发症发生状况，加强对肺部感染的预防和治疗是决定手术成败的关键。

Objective To explore the operative treatment of esophageal carcinoma or carcinoma of gastric cardia in patients aged 70 years or older. Methods One thousand and eighty eight patients with esophageal cancer or carcinoma of gastric cardia were retrospectively reviewed. These patients were divided into 4 groups： aged 41- 69,70 - 74, 75 - 79 and 80 - 90 years. The postoperative complications, hospitalization time, prognosis, operative selection and perioperative treatment were analyzed. Results Incidences of complications of pulmonary infection, arrhythmia, psychiatric symptom and unhealing of surgical incision were obviously increased, and the average hospitalization time were significantly prolonged in patients aged 70 years or older. Incidence of pulmonary infection and the average hospitalization time were significantly increased in patients aged 80 ~ 90 years compared with other groups. There were 4 death cases and 1084 cured cases. Conclusions With regard to elderly patients for esophageal carcinoma or carcinoma of gastric cardia, handling the occurrence of postoperative complications, selecting suitable patients to take operation and appropriate perioperative treatments are the keys for successful operation.