胸中下段食管癌术后肺部并发症的临床研究

Clinical study on respiratory complications after operation for middle and lower thoracic esophageal carcinoma

目的探讨胸中下段食管癌术后肺部并发症发生的主要原因及防治措施。方法回顾性分析412例胸中下段食管癌的患者资料,对患者的手术方式、术前伴发疾病、围术期用血、抗生素使用等与术后肺部并发症关系进行分析。结果 412例患者术后肺部并发症68例(16.5%),同时出现两种或两种以上并发症者24例(5.8%),围术期手术死亡2例,病死率0.4%,长期大量吸烟、肺部基础病变、围术期用血、三切口术式、手术时间≥5h、机械通气时间延长者术后肺部并发症发生率增加(P<0.05),而FEV1%、术中失血、抗生素使用时间、围术期放、化疗和TNM分期、病理类型对其肺部并发症的发生无明显差异(P>0.05)。结论注重治疗肺部基础疾病,加强患者围手术期的处理,充分的术前准备,合理选择手术方式,提高手术技巧,减少围术期用血将有利于减少肺部并发症的发生和控制其发展。

Objective To analyze the reasons for postoperative pulmonary complication in patients with the middle and lower thoracic esophageal carcinoma and investigate the reasonable methods to cure and prevent it. Methods Clinical data of 412 cases of the middle and lower thoracic esophageal carcinoma were analyzed retrospectively,and the association between postoperative respiratory complications and operational methods, preopeartive complications, perioperative blood-transfusion, or the using of antibiotic and pulmonary complication were analyzed. Result 68 cases（ 16.5% ） had pulmonary complication,24 cases（5.8% ） had two or more kinds of complications ,2 cases died during perioperation period （mortality rate 1.5% ）. Smoking, pulmonary diseases, perioperative blood-transfusion, tri-incisiong operation, operation lasted for more than5 hours, and long mechanical ventilation time were factors affecting complications （P 〈 0. 05 ）. But FEV1%, blood loss,time using medicine, perioperative radiotherapy and chemotherapy, TNM staging, and histological type were not associated with increased morbidity （ P 〉 O. 05 ）. Conclusion Emphasis on treatment of the associated pulmonary diseases, intensifying pefioperative dealing of patients, full preoperative preparations, reasonable choosing of procedure for operation, improvement of operation skill, and reducing blood-transfusion during the preoperative period help to reduce the occurrence and control the development of postoperative pulmonary complication.