老年胃癌患者合并心肺疾病的围术期处理

Perioperative elderly patients with gastric cardiopulmonary disease treatment

目的：探讨老年胃癌患者合并心肺疾病的围术期处理方法。方法对2003年3月至2013年12月解放军第一一三医院收治的296例合并心肺疾病的老年胃癌患者的围术期处理的临床资料进行回顾性分析，其中合并心血管疾病152例（51．4％），合并呼吸系统疾病74例（25．0％），同时合并两种疾病57例（19．3％）。 TNM分期为：IA 13例，IB 7例，Ⅱ21例，ⅢA 134例，ⅢB 73例，Ⅳ48例。结果296例患者均顺利完成手术，无术中死亡病例。术后并发症共79例，其中肺部感染26例，返流性食管炎6例，应激性溃疡6例，泌尿系感染5例，吻合口出血5例，急性胰腺炎5例，切口感染裂开5例，功能性排空障碍4例，输出襻不全梗阻4例，吻合口瘘（包括十二指肠残端瘘）3例。围术期死亡8例，包括心肺功能衰竭5例，DIC 1例，急性心肌梗死2例。结论老年胃癌合并心肺疾病明显增加了手术的风险，但加强围术期处理可提高手术的安全性，降低围术期病死率和并发症的发生率。

Objective To investigate the perioperative managements of aged gastric cancer patients combined cardiopulmonary comorbidity .Methods Perioperative clinical data in elderly patients admitted to our hospital 296 gastric cancer cases with cardiopulmonary disease treatment were analyzed retrospectively from March 2003 to December 2013.A-mong them,152 cases （51.4%） were combined cardiovascular diseases .and 74 cases （25.0%） were combined pulmonary diseases,and 57 cases （19.3%） were combined both diseases.there were stage IA in 13 cases,stage IB 7 cases,stage II 21 cases,stage ⅢA 134 cases,stage ⅢB 73 cases and stage Ⅳ48 cases according to TNM staging .Results All 296 cases were performed surgical treatment without intraoperative death .there were 79 cases of main postperative complications including 26 cases of pulmonary infection ,6 cases of reflux esophagitis ,6 cases of Stress ulcer ,5 cases of urinary system infection,5 cases of anastomotic bleeding ,5 cases of acute pancreatitis ,5 cases of infection and disruption of incisional wound ,4 cases of functional evacuation disorder ,4 cases of partial obstruction of export loop ,3 cases of anastomotic fistula （ including duodenal stump fistula ） .Eight patients died during perioperative period：5 died of cardiorespiratory function failure ,1 of disseminated intravascular coagulopathy （ DIC） and 2 of acute myocardial infarction .Conclusions Cardiopulmonary comorbidity can increase the operative risk of elderly patients with gastric cancer .The exact and reasonable perioperative managements for cardiopulmonary comorbidity not only can reduce the risk of operation ,but also decrease the incidence of operative complication and perioperative mortality .