低肺功能食管癌高龄患者的围术期治疗探讨

The discussion for the perioperative treatment of the elderly patients with esophageal carcinoma and lower pulmonary function

目的探讨低肺功能食管癌高龄患者围术期治疗的手术适应证及治疗方法,以减少患者并发症,为术后早日康复创造有利条件。方法42例高龄食管癌患者依据最大通气量占预计值百分比(MVV占预计值%)分为3组:Ⅰ组10例,MVV占预计值%>60%;Ⅱ组24例,40%≤MVV占预计值%≤60%;Ⅲ组8例,MVV占预计值%<40%,对比3组患者手术后心律失常及呼吸衰竭发生情况。结果Ⅰ组患者无该情况发生;Ⅱ组患者2例出现呼吸衰竭,4例出现心律失常;Ⅲ组患者4例出现呼吸衰竭,4例出现心律失常,且手术后死亡1例。结论高龄食管癌患者多合并肺功能减低,肺功能受损越重,严重并发症发生越多。通过术前针对性的处理,术中术后密切监护,及时治疗,是减少术后并发症,提高手术成功率的关键。

Objective To study operation indication and treating method to the elderly with lower lung function and esophageal cancer during perioperative period of surgical treatment so as to reduce complications and create the favorable conditions for the speedy recovery. Methods Based on the maximum expected value of the percentage of total ventilation （MVV%） ,42 cases of elderly patients with esophageal cancer were divided into 3 groups,with 10 cases, in group I MVV 〉60%, 24 cases in group II 40% ≤MVV≤60% ,8 cases in group Ⅲ MVV 〈40%. Then we compared the arrhythmias and the occurrence of respiratory failure of the patients in the three groups. Results The results showed that no such occurrences took place in group I; 2 cases in group II suffered from respiratory failure; 4 cases in group Ill suffered from arrhythmia and 4 eases with respiratory failure, of which one case with arrhythmia died after the surgery. Conclusion The pulmonary function of most elderly patients with esophageal cancer was low. The more serious the pulmonary function was hurt,the more serious complications were. The direct pre-operative treatment, the close monitoring and prompt treatment during or after the operation are the keys in reducing post-operative complications and improving the achievement ratio of the surgery.