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目的 为了探讨食管癌贲门癌合并哮喘的最佳治疗方法以提高生存率及生活质量。方法 我院于 1994年 3月～ 1998年 12月共收治此类病人 15例 ,均采用左后外侧开胸 ,食管贲门癌切除 ,胃代食管 ,食管 胃吻合术并附以左肺减容术 ,食管胃颈部吻合 4例 ,弓上吻合 2例 ,弓下吻合 9例 ;减容术 15例 ,左上叶切除 7例 ,肺段切除术 5例 ,楔形切除 3例。分别在术前、术后 ,一周、四周、三月分别测试肺功能、血气、6分钟走。结果 术后出现并发症 6例 (4 0 % )其中肺部感染 1例 ,心律失常 3例 ,支气管胸膜瘘 2例 ,死亡 2例为心肺功能衰竭。术后四周测定 13例病人肺功能、6分钟走、血气等各项指标均比术前不同程度地改善 ,3个月最为明显。FEV1术前 1.15± 0 .0 6 (L) ,术后为 1.43± 0 .12 (L) ;FVC术前 2 .6 5± 0 .2 5 (L) ,术后 3 .0 6± 0 .2 0 (L) ,PaO2 术前 6 9.4± 4(mmHg) ,术后 75± 4(mmHg) ;6分钟走术前 12 0 0±10m ,术后 14 75± 15m。呼吸困难指数术后平均下降 1.5分。结论 早中期食管贲门癌合并哮喘采用一次性肿瘤切除及肺减容术。术后病人生活质量及生存率有不同程度提高 ,是一种有效的治疗方法。
Objective To explore the best treatment for esophageal and cardiac cancer with asthma in order to improve the survival rate and quality of life. METHODS: From March 1994 to December 1998, 15 patients were treated in our hospital. All patients were treated with left posterolateral thoracotomy, esophageal and cardiac cancer resection, gastroesophageal esophageal, and esophagogastric anastomosis with left lung volume reduction. There were 4 cases of esophagogastric neck anastomosis, 2 cases of anastomosis on the arch, 9 cases of anastomosis under the arch, 15 cases of volume reduction surgery, 7 cases of left upper lobe resection, 5 cases of segmental resection, and 3 cases of wedge resection. Lung function, blood gas, and 6-minute walk were tested before and after surgery, one week, four weeks, and three months, respectively. Results Postoperative complications occurred in 6 cases (40%), including 1 case of pulmonary infection, 3 cases of arrhythmia, 2 cases of bronchopleural fistula, and 2 cases of heart and lung failure. Four weeks after surgery, 13 cases of lung function, 6 minutes walking, blood gas and other indicators were improved to different degrees before surgery, 3 months is the most obvious. FEV1 preoperatively was 1.15±0.06 (L), postoperatively 1.43±0.12 (L); FVC preoperatively 2.65±0.25 (L), postoperative 3.06±0. 20 (L), PaO2 preoperatively 69.4 ± 4 (mmHg), postoperative 75 ± 4 (mmHg); 6 minutes before surgery 120 0 ± 10m, postoperative 14 75 ± 15m. The respiratory distress index decreased by an average of 1.5 points. Conclusion Early and mid-stage esophageal and cardiac cancer combined with asthma use one-time tumor resection and lung volume reduction. Postoperative patients’ quality of life and survival rate have improved to different degrees, and it is an effective treatment method.