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目的 探讨食管贲门癌术后心血管并发症综合防治方案。方法 研究分两个阶段:第一阶段对前20年(1973～1992年)1208例食管贲门癌临床资料进行回顾性分析。第二阶段,对近5年(1993～1997)318例老年食管贲门癌病人进行前瞻性临床研究;随机分为A组(n=114),应用综合防治方案,即术前静滴心脏激化液(葡萄糖、胰岛素、氯化钾、GIK),避免术中低血压及术后联合应用肝素、氨茶硷等;B组(n=204),作为对照。结果 第一阶段回顾性分析表明:术后心血管并发症的危险因素是年老、术前心肺功能异常、术中低血压及主动脉弓上吻合术式,其直接原因是术后缺氧。第二阶段318例病人中,术后心血管并发症A组70%,B组216%(P<001);手术治愈率A组992%,B组971%(P<001)。结论 综合防治方案可以减少食管贲门癌术后心血管并发症的危险性,提高外科治疗水平。
Objective To investigate the comprehensive prevention and treatment of cardiovascular complications after esophageal and cardiac cancer surgery. Methods The study was divided into two phases: The first phase performed a retrospective analysis of the clinical data of 1208 cases of esophageal and cardiac cancer in the first 20 years (1973-1992). In the second stage, a prospective clinical study of 318 elderly patients with esophageal and cardiac cancer in the past 5 years (1993-1997) was randomly divided into group A (n = 114) and a comprehensive prevention and treatment program was used. Preoperative infusion of cardiac stimulating solution (glucose, insulin, potassium chloride, GIK), to avoid intraoperative hypotension and postoperative combined use of heparin, ammomycin, etc.; group B (n=204) as a control. Results The first stage retrospective analysis showed that the risk factors for postoperative cardiovascular complications were old age, preoperative cardiac and pulmonary function abnormalities, intraoperative hypotension and aortic arch anastomosis. The direct cause was postoperative hypoxia. In the second phase of 318 patients, postoperative cardiovascular complications were 70% in group A and 21% in group B (P < 001). The surgical cure rate was 99% in group A and 97% in group B (P < 001). Conclusion Comprehensive prevention and treatment programs can reduce the risk of cardiovascular complications after esophageal and cardiac cancer surgery and improve the surgical treatment.