食管肿瘤；_外科手术；_并发症；

70岁以上食管癌患者术式选择及并发症的原因分析

http://www.100md.com 《实用老年医学》 2006年第4期

食管肿瘤；,外科手术；,并发症；,老年人,1临床资料,2结果,3讨论,参考文献

     【摘要】目的探讨(≥70岁)食管癌手术方式的选择以及术前危险因素对术后并发症的影响。方法对47 例≥70岁食管癌手术治疗的患者进行回顾性分析。结果该组病例中，选择颈、胸、腹三切口术式的患者29例，左胸一切口术式的患者18例。术后主要并发症为吻合口瘘和肺部并发症，吻合口瘘的发生与手术方式密切相关，三切口组吻合口瘘的发生率(379%)远高于一切口组(0)(P<005)。肺部并发症的发生与手术方式及患者肺功能密切相关，术前肺功能正常的患者，三切口肺部并发症的发生率高达345%，显著高于选择一切口术式组(111% )(P<005)。结论对≥70岁患者尽量避免使用三切口，尤其是食管中、下段癌患者，且加强围手术期呼吸道的管理对减少肺部并发症的发生至关重要。

    【主题词】食管肿瘤；外科手术；并发症；老年人

    Effects of preoperative risk factors and different operative methods on postoperative complications in elderly patients with esophageal cancer

    SUN Chao, SHI Weiping, SHU Yusheng, SHI Hongcan, LU Shichun, WANG Kang.

    Department of Cardiothoracic Surgery, Subei People’s Hospital Affiliated to Yangzhou University, Yangzhou 225001 China

    【Abstract】 Objective To investigate the relationship between preoperative risk factors, operative methods and postoperative complications in elderly patients with esophageal cancer(≥70 years old). Methods A retrospective review was performed on 47 consecutive patients aged 70 and over with esophageal cancer who underwent radical tumor resection. Resukts Twentynine patients underwent threeincision operation and 18 patients underwent oneincision operation. The main postoperative complications were anastomotic leak and respiratory complications. The development of anastomotic leak was closely related with the operation method. The incidence rate of anastomotic leak in threeincision approach(379%) was significantly higher than that in oneincision approach(0)(P<005). The development of respiratory complications was closely related to preoperative pulmonary function and the operative method. The incidence rate of respiratory complications in threeincision approach(345%) was significantly higher than that in oneincision approach(11.5%)(P<005). Conckusions Threeincision approach should not be selected for the operative treatment of esophageal cancer in elderly patients. It is very important to enhance the management of respiratory treatment in the perioperative period. ......

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