56例70岁以上高龄低肺功能食管癌患者围手术期处理

Perioperative management of 56 esophageal cancer patients over the age of 70 with low pulmonary function

目的探讨高龄低肺功能食管癌患者围手术期处理的注意事项。方法回顾性分析2006年10月～2011年10月我院心胸外科手术治疗的56例70岁以上高龄低肺功能食管癌患者围手术期处理的临床资料。全组高龄食管癌患者均有不同程度的肺功能减低,其中男39例,女17例;年龄70～82岁,平均年龄73.6岁。术前经戒烟,控制呼吸道感染及氧疗改善肺功能后,行左经胸食管癌肿切除,胸内弓上食管胃吻合术32例。行左经胸食管癌肿切除,胸内弓下食管胃吻合术17例。行右经胸食管癌肿切除,正中经腹左经颈食管胃吻合术7例。术后给予抗感染、解痉镇痛、全组患者均保留气管插管及呼吸机辅助呼吸,辅助时间8h～14d。结果全组术后发生肺部感染6例、呼吸衰竭3例、心律失常4例,早期因肺部感染死亡1例,其余患者均治愈出院。结论加强围手术期处理和肺功能保护对于高龄低肺功能食管癌患者的手术成功具有重要作用。

Objective To explore the perioperative management and cautions of elderly esophageal cancer patients with low pulmonary function. Methods Fifty-six esophageal cancer patients over the age of 70 with low lung function were retrospectively analysed from October 2009 to October 2010 in this hospital, and their perioperative clinical data were collected. The patients had different levels of reduced lung function, including 39 males and 17 females;aged from 70 to 82, with a mean age of 73. 6 years. Preoperative smoking cessation, control of respiratory infections and oxygen therapy to improve lung function were administered to these patients. Thirty-two patients were given by esophagectomy from left thorax and esophagogastrostomy over thoracic arch; 17 patients by esophagectomy from left thorax and esophagogastrostomy below thoracic arch; 7 patients by esophagectomy from right thorax and esophagogastrostomy from left abdominals and left cervix. After giving antibiotics, antispasmodic drugs,all patients had retained endotracheal intubation and ventilator-assisted breathing from 8 h to 14 d based on situation of patients. Results Six patients occurred postoperative pulmonary infection and 1 patient died from infection. Three cases had respiratory failure, and 4 cases had arrhythmia. The remaining patients were cured. Conclusions Perioperative management and to strengthen protection for the elderly esophageal cancer patients with low lung function, play important roles in the success of operation.