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目的总结并探讨高龄食管癌患者外科治疗效果及临床体会。方法回顾性分析我院2008年3月至2011年5月收治行外科手术治疗高龄食管癌患者103例临床治疗及术后随访资料,其中患者平均年龄为73.4岁,平均病程为6.3个月,合并有高血压12例,慢性阻塞性肺疾病24例,心功能异常37例,糖尿病20例,甲状腺功能异常5例;按照肿瘤病理分型划分,腺癌14例,小细胞癌2例,腺鳞癌3例,鳞癌84例。结果本组患者均顺利完成食管癌切除手术,术后检查显示无癌变组织残留;术后发生并发症29例,并发症发生率为28.2%,其中肺部感染9例、肺不张2例、肺栓塞1例、ARDS2例、心功能衰竭3例,心律失常4例,喉返神经麻痹2例,功能性胃排空障碍4例,吻合口瘘2例。患者术后行辅助放化疗11例,呼吸机辅助支持5例;全部患者出院后均得到随访,随访率为100%,随访时间6-12个月;随访期间患者中11例死亡,1年存活率为89.3%,其中死于食管癌转移7例,呼吸功能衰竭2例,心肌梗死2例。结论在身体机能足以耐受手术治疗基础上,通过严格掌握手术适应证,加强围手术期处理,有效预防并发症发生,高龄食管癌患者外科治疗效果确切,癌变切除彻底,1年随访生存率高,具有临床推广使用价值。
Objective To summarize and discuss the surgical treatment of elderly patients with esophageal cancer and clinical experience. Methods A retrospective analysis of our hospital from March 2008 to May 2011 received surgical treatment of elderly patients with esophageal cancer in 103 cases of clinical treatment and postoperative follow-up data, of which the average age was 73.4 years with an average duration of 6.3 months, the merger Hypertension in 12 cases, 24 cases of chronic obstructive pulmonary disease, cardiac dysfunction in 37 cases, 20 cases of diabetes, thyroid dysfunction in 5 cases; according to the tumor pathological classification, adenocarcinoma in 14 cases, 2 cases of small cell carcinoma, adenosquamous 3 cases of cancer, squamous cell carcinoma of 84 cases. Results The patients were successfully completed esophageal cancer resection surgery, postoperative examination showed no residual cancerous tissue; postoperative complications occurred in 29 cases, the complication rate was 28.2%, of which 9 cases of pulmonary infection, 2 cases of atelectasis, 1 case of pulmonary embolism, 2 cases of ARDS, 3 cases of heart failure, 4 cases of cardiac arrhythmia, 2 cases of recurrent laryngeal nerve paralysis, 4 cases of functional gastric emptying disorder and 2 cases of anastomotic fistula. All the patients were followed up after discharge, the follow-up rate was 100% and the follow-up time was 6-12 months. Eleven patients died and one year survived during follow-up The rate of 89.3%, of which 7 died of esophageal cancer metastasis, respiratory failure in 2 cases, 2 cases of myocardial infarction. Conclusions Based on the sufficient body function to tolerate surgical treatment, surgical treatment of elderly patients with esophageal cancer can be confirmed by rigorous surgical indications, perioperative management and effective prevention of complications. Complete resection of cancerous lesions and high survival rate at one-year follow-up , With clinical use value.