高龄食管癌患者术后肺部并发症的防治

Prevention and treatment of postoperative pulmonary complications after esophagectomy in elderly patients with esophageal carcinoma

目的探讨高龄食管癌患者术后并发症的防治策略。方法回顾性分析41例高龄(≥70岁)食管癌患者的临床资料。根据术前综合评估情况选择手术方式:其中行食管癌根治、胃代食管吻合术29例(右胸上腹二切口14例,颈胸腹三切口9例,左胸切口4例,左胸腹联合切口2例),行食管癌切除、颈段食管外置12例。术后加强呼吸道管理,及早发现并积极处理肺部并发症。结果围手术期肺栓塞1例,继发多脏器功能衰竭死亡。术后发生肺部感染2例,肺不张2例,呼吸功能衰竭3例。结论细致的术前评估和准备、管状胃重建消化道、积极有效的呼吸道管理是术后肺部并发症防治的关键。

Objective To explore the prevention and treatment measures of postoperative pulmonary complications after esophagectomy in elderly patients with esophageal carcinoma.MethodsThe clinical data of 41 elderly patients with esophageal carcinoma were retrospectively reviewed with respect to the general conditions,cardiopulmonary function,tumor grade and scheduled protocols of surgical intervention.Of the 41 patients,29 underwent esophagogastrostomy（right chest,upper abdomen incision in 14;neck,chest and abdomen incision in 9;single left chest incision in 4;and left thoracoabdominal incision in 2）.The other patients received esophagectomy and cervical esophageal externalization.Postoperative pulmonary complications were treated timely.Results One died of multiple system organ failure followed by pulmonary embolism.There were 2cases of pulmonary infection,2cases of atelectasis and 3cases of respiratory failure.Conclusions Cautious preoperative assessment,gastric tube reconstruction and respiratory management are crucial steps in prevention and treatment of postoperative pulmonary complications after esophagectomy in elderly patients with esophageal carcinoma.