136例高龄食管癌、贲门癌患者的外科手术治疗体会

The surgical treatment experience of 136 esophageal and gastric cardia carcinoma patients with elderly age

目的总结>70岁高龄食管癌、贲门癌患者的外科治疗经验。方法回顾性分析2008年1月～2011年4月在我科手术治疗的136例>70岁高龄食管癌、贲门癌患者的临床资料(≥80岁24例)。结果全组均行肿瘤根治术。手术时间(141.5±48.7)min。术后发生吻合口瘘3例,肺不张4例,肺部感染12例,呼吸衰竭9例,急性肾功能衰竭2例,心律失常15例,伤口感染2例,乳糜胸1例;死亡3例,其余均经治疗后痊愈出院。术后平均住院时间(12.3±3.4)d。随访78例,随访1～39个月,10例死亡,其中4例死于肿瘤复发或者远处转移,6例死于心脑血管意外,其余患者生活质量良好。结论在合理掌握适应证的前提下,对>70岁高龄食管癌、贲门癌患者进行积极的手术治疗是安全有效的,但对各种并发症应有充分的认识,同时需要加强围术期管理。

Objective To summarize the surgical treatment experience of esophageal and gastric cardia carcinoma patients with elderly age（ over 70 years old）. Methods The clinical data about 136 cases of esophageal and gastric cardia carcinoma pa- tient over 70 years old underwent surgery from January 2008 to April 2011 was retrospectively analysed. Results All patients were received carcinoma radical mastectomy. The operation time was mean （141.5±48.7） minutes. After operation, 3 cases of anastomotic leakage patient, 4 case of pulmonary atelectasis patient, 12 cases of pulmonary infection patient, 9 cases of respiratory failure patient, 2 cases of acute renal failure patient, 15 cases of arrhythmias patient, 2 cases of incision infection patient and 1 case of flecked chest patient were found. 3 patients died and other patients were cured and discharged. Postoperative hospital stay was mean （ 12. 3 ＋-3.4） days. 78 patients were followed-up from 1 to 39 months. 4 patients died of carcinoma recurrence or dis- tant metastasis and 6 patients died of myocardial infarction or cerebral hemorrhage. Other patients had a high quality life. Conclusion If the operation indication of esophageal and gastric cardia carcinoma patients with elderly age was reasonable, the understanding of various operation-related complications was enough and perioperative period management was good, the surgical treatment is safe and effective.