40例高龄食管癌贲门癌患者的外科治疗临床分析  

The Surgical Treatment of Esophageal and Gastric Cardia Carcinoma Patients with Elderly Age(40 Cases)

作　　者：王有贵[1] 洪卫东[1] 卢金山[1] 陈健[1] 汪苏波[1] 张琨[1] 倪玉宝[1] 

机构地区：[1]安徽省滁州市第一人民医院心胸外科,239000

出　　处：《中华全科医学》2013年第4期567-568,共2页Chinese Journal of General Practice

摘　　要：目的主要探讨70岁及以上食管癌贲门癌患者的围手术期的处理经验和并发症的防治。方法总结自2008年5月-2012年8月共手术40例70岁及以上的食管癌贲门癌的患者,分析围手术期处理方法。其中食管下段癌3例,食管中段癌29例,食管上段癌1例,贲门癌7例,男性27例,女性13例,年龄70～82岁,食管-胃弓上吻合术30例(颈部吻合1例),食管-胃弓下吻合10例,左进胸38例,右胸腹二切口1例,右胸颈腹三切口1例。结果 39例康复出院,术后并发症发生:吻合口瘘3例,占7.5%;切口愈合不良6例,占15%;心律失常2例,占5%;肺部感染4例,占10%;消化功能紊乱5例,占12.5%;胸腔积液5例,占12.5%,均给予积极处理后治愈。无死亡病例。结论对于70岁及以上老年食管癌贲门癌患者,严格掌握手术适应证,加强围手术期管理,控制感染,保持各种引流管通畅、加强营养支持,正确、及时处理基础性疾病,有效地预防和处理并发症,大多可以康复出院。Objective To summarize the perioperative period management experience and to treatment various operation-related complications of esophageal and gastric carcinoma patients with elderly age（70 and 70 years old above）.Methods 40 cases esophageal and gastric carcinoma patients with elderly age（70 and 70 years old above） were operated in our department from May 2008 to August 2012,and analyzed the ways of perioperative period management,with male 27,female 13,aged from 70 to 82 years old,3 cases of the tumors were located in the upper esophagus,29 in the middle,and 1 in the lower,7 cases of gastric carcinoma;30 cases esophagogastrostomy were anas-tomsed above aortic arch（1 case anastomosed in neck）,10 cases below the aortic arch,38 cases through left thoracotomy approach,1 case through right thoracic and abdominal incisions two,1 case through cervico-right thoracic-abdominal triple incision.Results 39 patients were cured and discharged,there were 3 patients with anastomotic leakage（7.5%）,6 patients with incision infection（15%）,2 patients with arrhythmias（5%）,4 patients with pulmonary infection（10%）,and 5 patients with pleural effusions,all were cured actively,with no death.Conclusion With effective prevention and treatment of complications,keeping all kinds of the drainage tube unblocked,nutritional support,perioperative period management,and infection control,the surgical treatment was safe and effective,if the basic diseases were dealt actively,most of esophageal and gastric carcinoma patients with elderly age can be cured and discharged.

关 键 词：高龄 食管癌 贲门癌 外科手术 

分 类 号：R735.1[医药卫生—肿瘤] R730.56[医药卫生—临床医学]