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报告严重胸廓畸形食管贲门癌手术死亡 4例 ,其主要原因是漏斗胸、脊柱严重侧凸致胸廓畸形、内脏呈代偿性存在不同移位、主要呼吸肌发育不全、平素心肺功能储备低下 ,呈现运动耐量减退 ,加之手术使膈肌、肋间肌等遭到破坏 ,另有胸部占位、感染等综合因素 ,其手术死亡率甚高。从 1976年 11月～ 1989年 9月共行此类手术 4例均死亡 ,死亡原因均为术后呼吸衰竭。自 1989年 9月以来 ,对此类患者围手术期采取了改进措施 ,行同类手术 2例均顺利痊愈出院。改进措施主要是根据具体情况选择理想方式 ,即围绕对畸形胸廓的完整性不被破坏或尽可能使其损伤减少到最低限度 ,术后早期应用呼吸机支持 ,以偿还氧债。
Reported severe thoracic deformity in 4 cases of esophageal and cardiac cancer surgery, mainly due to thoracic deformity caused by funnel thoracic, spinal scoliosis, compensatory displacement of viscera, major respiratory muscle hypoplasia, and low reserve of cardiopulmonary function. Loss of exercise tolerance, combined with surgery to make the diaphragm, intercostal muscles, etc. have been destroyed, and other factors such as chest occupation, infection, the operative mortality rate is very high. From November 1976 to September 1989, 4 cases of these operations all died. The cause of death was postoperative respiratory failure. Since September 1989, improvement measures have been taken for such patients during the perioperative period, and 2 cases of similar operations have been successfully cured and discharged. Improvement measures are mainly based on the specific situation to choose the ideal way, that is, around the integrity of the deformity of the thorax is not destroyed or minimize its damage to a minimum, after the early use of ventilator support to pay off the oxygen debt.