食管癌放疗后手术脓胸的预防  

PREVENTION OF PYOTHORAX IN OPERATION ON CARCINOMA OF ESOPHAGUS AFTER RADIOTHRAPY

作　　者：姜利[1] 信德和[1] 杨可贤 段德溥[1] 才志刚[1] 张珩[1] 张绍明[1] 

机构地区：[1]解放军第四五五医院,上海200052

出　　处：《中国癌症杂志》1998年第3期185-186,共2页China Oncology

摘　　要：目的研究食管癌放疗后手术脓胸的特点及预防。方法术前深静脉高营养，肠道消毒，穿孔病例控制毒血症。术中严格无茵操作，对食管穿孔、破损、残留处以碘伏，洁尔灭酊消毒，高频氩气电刀烧灼。关胸前碘伏，洗必泰，盐水反复冲洗。术后加强呼吸道及胸腔引流管管理，防止胸腔积液，合理使用抗生素。结果121例病人术后脓胸2例，占1．65％。结论食管癌放疗后手术团术前穿孔率高，胸内心肺脏器生理功能发生不同程度改变，术中肿瘤破损及残留机会多，易发生脓胸。本组术前、术中、术后采取严密施治，可有效地预防脓胸的发生。To study the characteristics and prevention of pyothorax in operation on carinoma of eaophagusafter radiotherapy. METHODS Preoperatively deep intravenous hyperlimentation and intestinal disinfection wereadministered: with septicemia controlled in perforated cases. During the operation strict aseptic technique wasadopted. In cases of esophagel perforation 'dian-fu' and tinctute of benzalkonium bromide were applied to disinfectthe ruptured and residual tumor area supplemented by high frequency argon gas electric knife cautery. Before closure the thoracic cavity was further disinfected by diluted 'dian-fu' and chlorhexidine. and finally by repeated salineirrigation. Postoperatively the management of respiratory passage was strengthened and also the chest drainagetube for the prevention of accumulation of fluid within the thoracic cavity. The antibiotics should be reasonablyadministered. RESULTS There occurred 2 cases of pyothorax postoperatively out of 121 patient of 1. 65%. CONCLUSION Because of high incidence of preoperative perforation on carcinoma of esophagus after radiotherapy andthe occurrence of different degree of changes in physiological function intrathoracic cardiopulmonary organs, and anincrease in chance of tumor rupture and tumor residue during the operation. pyothorax was liable to happen, Stricttherapeutic measures were undertaken in our series preoperatively, intraoperatively and postoperatively, thuspyothorax.

关 键 词：食管癌 放射疗法 脓胸 预防 外科手术 

分 类 号：R735.105[医药卫生—肿瘤] R561.601[医药卫生—临床医学]