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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 investigate the perioperative management experience and prevention and treatment of patients with esophageal and cardiac cancer of 70 years old and above. Methods From April 2008 to August 2012, 40 patients with esophageal and cardiac cancer of 70 years old and above were enrolled. Methods of perioperative management were analyzed. Among them, there were 3 cases of lower esophageal cancer, 29 cases of middle esophageal cancer, 1 case of upper esophageal cancer, 7 cases of cardia cancer, 27 males and 13 females, aged 70-82 years old, 30 cases of esophageal-gastric anastomosis Anastomosis in 1 case), esophageal-gastric anastomosis in 10 cases, left into the chest in 38 cases, right thoracodor incision in 1 case, right thoracotomy in 3 cases. Results 39 cases were recovered and discharged from the hospital. Postoperative complications occurred in 3 cases (7.5%), 6 cases (15%) of incision healed, 2 cases of arrhythmia (5%), 4 cases of pulmonary infection (10% ; Digestive disorders in 5 cases, accounting for 12.5%; pleural effusion in 5 cases, accounting for 12.5%, were given a positive treatment and cure. No deaths. Conclusion For elderly patients with esophageal and gastric cardia cancer of 70 years of age and older, strict indications of surgical operation, strict perioperative management, infection control, patency of various drainage tubes, nutritional support, correct and timely treatment of basic diseases and effective prevention And to deal with complications, most of them can be discharged.