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目的:食管癌患者营养状况差,年龄较大,肺功能欠佳,同时食管癌手术涉及胸、腹及颈部器官,手术创伤大、复杂、耗时长,术后并发症亦较多。减少食管癌术后并发症的发生,降低死亡率是食管外科中应予十分重视的问题。本研究的目的是探讨食管癌切除术的主要并发症及危险因素,对手术治疗效果进行评估。方法:分析研究本院肿瘤外科1996年3月至2007年3月期间实施的689例食管癌切除术术后主要并发症的发生情况。结果:食管癌切除术后并发症发病率为19.9%,其中肺部并发症9.3%,吻合口瘘4.8%,气胸2.8%,乳糜胸0.9%,脓胸0.6%。院内死亡率为3.6%,因肺部并发症死亡者占56.0%,因吻合口瘘死亡者占20.0%。颈部吻合的瘘发病率高于胸内吻合(P<0.01):吻合器吻合的瘘发病率、肺部并发症发病率及院内死亡率均低于手工吻合(P<0.05),瘘死亡率及肺部并发症死亡率两者无显著差异;肿瘤位置是术后并发症的独立危险因素。结论:食管癌切除术后并发症仍以肺部并发症和吻合口瘘多见,且为主要死亡原因。使用吻合器能显著降低术后并发症的发生率及死亡率。
Objective: Esophageal cancer patients with poor nutritional status, older, poor lung function, while esophageal cancer involving the chest, abdomen and neck organs, surgical trauma, complicated, time-consuming, postoperative complications are more. Reduce the incidence of postoperative complications of esophageal cancer, reduce mortality is esophageal surgery should be given great importance. The purpose of this study is to investigate the main complications and risk factors of resection of esophageal cancer and evaluate the effect of surgical treatment. Methods: To analyze the incidence of major complications after 689 esophageal cancer resections performed in our hospital from March 1996 to March 2007. Results: The incidence of complications after esophageal resection was 19.9%. The complications of the lung were 9.3%, anastomotic fistula 4.8%, pneumothorax 2.8%, chylothorax 0.9% and empyema 0.6%. Hospital mortality was 3.6%, deaths due to pulmonary complications accounted for 56.0%, due to anastomotic leakage accounted for 20.0%. The incidence of anastomosis of neck was higher than that of intrathoracic anastomosis (P <0.01). The incidence of anastomosis fistula, incidence of pulmonary complications and hospital mortality were lower than those of manual anastomosis (P <0.05) There was no significant difference between the two groups in the mortality of pulmonary complications. The location of the tumor was an independent risk factor for postoperative complications. Conclusion: The complications of esophageal cancer resection are still more common in pulmonary complications and anastomotic leakage, and are the main causes of death. The use of staplers can significantly reduce the incidence of postoperative complications and mortality.