142例食管癌合并肺功能不全患者的围手术期治疗

Effect of 142 cases of esophageal cancer with non- complete pulmonary function in perioperative treatment

目的:总结食管癌合并肺功能不全患者围手术期治疗的经验。方法:2010年7月-2013年10月,收集我院对食管癌合并肺功能不全行食管癌根治术患者142例,其中男86例,女56例,年龄46-75岁,平均年龄62.4岁。术前经严格禁烟,净化呼吸道,并给予雾化化痰、解痉、呼吸功能锻炼改善肺功能,术前合并肺部感染者,给予抗感染直至感染控制及呼吸道症状消失。经右胸前外侧切口、上腹部正中切口手术82例,左后外侧切口食管癌根治术36例,颈、胸、腹联合三切口手术24例,术后予以预防感染、解痉化痰保持呼吸道通畅、抑制抗炎介质释放、营养支持和氧气支持治疗,部分患者予以纤维支气管镜吸痰。结果:142例患者均顺利出院,无1例手术死亡,其中术后发生肺部感染12例,颈部吻合口瘘1例。142例均获随访,随访时间1-6个月,平均4.2个月。术后均恢复良好,经复查无手术相关并发症。结论:严格的围手术期处理对于提高肺功能不全食管癌患者手术成功具有重要意义。

Objective：To summary perioperative treatment experiences in patients with esophageal cancer with pulmonary disfunction. Methods：Of 142 cases of patients with esophageal cancer there were 86 males and 56 fe-males,age 46 - 75 years,average 62. 4 years. Strict no - smoking,purify respiratory tract,and to give atomization phlegm,spasmolysis,to improve lung function,infection control,on the right chest of the lateral incision abdominal midline incision surgery in 82 cases,36 cases of esophageal cancer radical left posterolateral incision,neck,chest,ab-domen combined three 24 cases incision surgery,postoperative infection were prevented. Results：All 142 cases were successfully discharged from the hospital,no operative death,12 cases of postoperative pulmonary infection,cervical anastomotic leakage in 1 case. 142 cases have been followed up,for 1 to 6 months,mean 4. 2 months. All recovered well postoperatively,no complications related to the operation. Conclusion：Strict perioperative management for im-proving lung dysfunction in patients with esophageal cancer is of great significance for surgery.