高龄低肺功能食管癌患者手术治疗的研究

A study of surgical treatment in aged patients with esophageal carcinoma and lower pulmonary function

目的 :探讨高龄低肺功能食管癌病人外科手术治疗适应症、手术方式的选择及术后呼吸机的应用。方法 :4 6例 70岁以上食管癌患者依据最大通气量占预计值百分比 (MVV ,% )分为 2组 :第一组 ,MVV≤ 5 0 % 2 2例 ,第二组为对照组 :MVV >5 0 % 2 4例 ;第一组再分 2组 :1组MVV <4 0 % 3例 ,其中 2例术前FEV1 FVC <4 5 % ,1例FEV1 FVC >4 5 % ;2组 :MVV 4 0 %～ 5 0 % 19例 ,FEV1 FVC均 >4 5 %。第一组患者术后均使用呼吸机辅助呼吸。对比研究 1组、2组患者及对照组呼吸衰竭、心律失常发生情况。结果 :各组无手术死亡 ;1组中 2例 (FEV1 FVC <4 5 % )同时发生呼吸衰竭及心房颤动 ;2组中 4例病人出现心律失常 ,无呼吸衰竭 ;对照组中 5例病人出现心律失常 ,无呼吸衰竭。结论 :由于手术技术提高和术后呼吸机的应用 。

Objective:To investigate the indication of surgical treatment,choice of operation program and application of post\|operative respirator in aged patients with esophageal carcinoma and lower pulmonary function.Method:According to pre\|operative maximal voluntary ventilation (MVV,%),46 over\|70\|year\|old patients with esophageal carcinoma and lower pulmonary function undergoing csophagectomy were divided into 2 groups:Group 1,22 patients (MVV≤50%).Group 2 (control Group),24 patients (MVV>50%).And Group 1 could be subdivided into 2 groups:Subgroup 1,3 patients (MVV<40% and 2 of them FEV\-1/FVC<45%,one FEV\-1/FVC>45%).Subgroup 2,19 patients FEV\-1/FVC>45%.Patients in Group 1 were in assisted respiration after operation.Patients in Subgroup 1 and Subgroup 2 were in comparison with ones in the occurrence of respiratory failure and arrhythmia.Result:There was no one dead in all of groups.Respiratory failure and Atrial fibrillation happened in 2 patients in Subgroup 1 (FEV\-1/FVC<45%) simultaneously;In Subgroup 2 and control Group,there were 4 and 5 patients respectively suffering from arrhythmia and no one in respiratory failure.Conclusion:With the improvement of surgical techniques and application of post\|operative respirator,the indication of surgical treatment could be enlarged relatively. [