食管癌和贲门癌术后并发症的防治  

Prevention and treatment of complications after surgical resection for esophageal and gastric cardiac cancers

作　　者：平育敏[1] 何明[1] 孟宪利[1] 白世祥[1] 陈新[1] 刘庆熠[1] 杨立伟[1] 张明道[1] 

机构地区：[1]河北医科大学第四医院胸外科,石家庄050011

出　　处：《中华医学杂志》2009年第5期296-300,共5页National Medical Journal of China

基　　金：基金项目：河北省教育厅高校强势特色学科资助项目（冀教高2005-52）

摘　　要：目的总结食管癌和贲门癌外科治疗并发症的发生趋势，提出防治对策，提高外科治疗水平。方法分析河北医科大学第四医院胸外科，1952年9月至2005年12月行食管癌和贲门癌手术后并发症种类和不同年代发生率和治疗结果。结果（1）食管癌和贲门癌手术20796例，切除18772例，术后有1741例发生各种并发症1837例次，发生率为9．27％（9．79％），住院死亡433例（24．87％）。（2）并发症发生率（39．77％）和病死率（44．29％）近年分别降至4．10％和15．42％。（3）与手术密切相关的并发症和病死率均呈明显下降趋势，如吻合曰瘘在20世纪50年代发生率4．55％和50．oo％死亡，近十年分别下降到1．21％和3．33％。（4）内科系统并发症发生率略有下降，但病死率很高，如肺部和心血管并发症死亡分别为27．42％和25．00％，已占术后死亡的第1、2位。结论（1）外科治疗食管癌的一大进展是并发症发生率和病死率明显下降。（2）在扩大手术适应证的同时应积极和针对性行术前准备，以减少全身性特别是肺部并发症。（3）外科技术是关键，当今防治吻合区瘘和胃壁坏死及胸腹腔出血仍是重点。Objective To summarize the experience in surgical resection for esophageal and gastric cardiac cancers so as to put forward countermeasures to prevent the post-operative complications. Methods From September 1952 to December 2005, 20 796 patients with esophageal and gastric cardiac cancers underwent surgical operation. The category and incidence of the complications in different decades were retrospectively analyzed. Results （ 1 ） 18 772 of the 20 796 patients with esophageal and gastric cardiac cancers underwent surgical resection. Operative complications occurred in 1741 patients （9.27%）, death occurred in 433 of which （24.87%）. （2） The complication rate was 39.77% in 1950s, and decreased to 4.10% in 2000s. The mortality rate of complication was 44.29% in 1950s, and decreased to 15.42% in 2000s. （3）The incidence and mortality rates of closely-surgery-related complications declined obviously over the period of study. The incidence and mortality rates of anastomotic leakage were 4.55% and 50.00% respectively in 1950s, and then decreased to 1.21% and 3.33% respectively in 2000s. The incidence and the mortality rates of empyema were 7.39% and 38.46% respectively in 1950s, and decreased to 0.36% and 5.56% respectively in 2000s. The incidence and the mortality rates of chylothorax was 0.16% and 0% recently. （4）The incidence of non-surgical-related complications declined slightly but the mortality rate was still very high over the period of study. The mortality rates of pulmonary and cardiovascular complication were 27.42% and 25.00% respectively recently. Conclusion （ 1 ） One of the advantages of surgical treatment for esophagus and gastric cardiac cancers is the obvious decline of the incidence and the mortality rates of complications. （2） In order to reduce the incidence of systemic complication, especially pulmonary complication, active and corresponding preoperative preparation should be improved along with the expansion of the scope of surgical indication. （3） The key for prev

关 键 词：食管肿瘤 贲门 手术后并发症 

分 类 号：R686[医药卫生—骨科学]