食管癌术后并发症分析与探讨
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摘要
目的:探讨食管癌手术治疗后出现的各种并发症。
材料与方法:抽取1999年3月至2009年3月在辽宁省人民医院胸外科病房住院治疗的264例食管癌患者作为研究对象,分析食管癌术后出现的各种并发症的发生情况,总结经验教训,更加合理地治疗食管癌,以提高手术根治率及术后生存率,改善患者的生活质量。
结果:食管癌术前合并其他疾病占74.2%,根治术后并发症总发生率为23.1%(61/264),其中肺部并发症16.7%,吻合口瘘3.4%,切口感染4.2%,心血管并发症1.1%,脓胸1.5%。并发症死亡率为1.5%(4/264)。
结论:食管癌根治术后并发症以肺部并发症、吻合口瘘多见,且为主要死亡原因。做好术前准备,治疗术前合并疾病,严格规范手术操作,是预防并发症的主要措施。
Purpose:To discuss the complications of the operations for carcinoma of the esophagus.
Material and method:The author collected and analyzed 264 cases to get the experences .With the information,we could make the treatment more reasonable and also improve the survival rate and cure rate.
Results:The author got the results as follow:1.The rate was 74.2% that the carcinoma of the esophagus occurred with other diseases together before the operations.2.The total rate was 23% that complications occurred after the operations.In these ones,lung complications occupied 16.7%,3.4% for leakage in anastomosis,4.2% for ineision infection,1.1% for cardiovascular illness,1.5% for empyema.3.The death rate of complications was 1.5%(4/264).
Conclusion:The main complications of operations for carcinoma of the esophagus are lung complications,leakage in anastomosis And they are also the main reasons why patients died.The best measures to prevent the complications are to prepare the operations well,to cure other illness before the operation and to observe the operation rules strictly.
材料与方法:抽取1999年3月至2009年3月在辽宁省人民医院胸外科病房住院治疗的264例食管癌患者作为研究对象,分析食管癌术后出现的各种并发症的发生情况,总结经验教训,更加合理地治疗食管癌,以提高手术根治率及术后生存率,改善患者的生活质量。
结果:食管癌术前合并其他疾病占74.2%,根治术后并发症总发生率为23.1%(61/264),其中肺部并发症16.7%,吻合口瘘3.4%,切口感染4.2%,心血管并发症1.1%,脓胸1.5%。并发症死亡率为1.5%(4/264)。
结论:食管癌根治术后并发症以肺部并发症、吻合口瘘多见,且为主要死亡原因。做好术前准备,治疗术前合并疾病,严格规范手术操作,是预防并发症的主要措施。
Purpose:To discuss the complications of the operations for carcinoma of the esophagus.
Material and method:The author collected and analyzed 264 cases to get the experences .With the information,we could make the treatment more reasonable and also improve the survival rate and cure rate.
Results:The author got the results as follow:1.The rate was 74.2% that the carcinoma of the esophagus occurred with other diseases together before the operations.2.The total rate was 23% that complications occurred after the operations.In these ones,lung complications occupied 16.7%,3.4% for leakage in anastomosis,4.2% for ineision infection,1.1% for cardiovascular illness,1.5% for empyema.3.The death rate of complications was 1.5%(4/264).
Conclusion:The main complications of operations for carcinoma of the esophagus are lung complications,leakage in anastomosis And they are also the main reasons why patients died.The best measures to prevent the complications are to prepare the operations well,to cure other illness before the operation and to observe the operation rules strictly.
引文
1. Greenlee RT,Hill Harmon MB,Murray T,et a1.Cancer statistics,200l[J].C A Cancer ciln,2001,51(1):15-36.
2. Pisani P,Parkin DM,Bray F,et a1.Estimates of the world wide mortality from 25 cancers in 1990[J].Int J Cancer,1999,83:18-29.
3.灏珠,实用内科学下册[M].北京:人民卫生出版社,2003:1721.
4.吴在德,吴肇汉,郑树.外科学[M].北京:人民卫生出版社,2005,368.
5.吴阶平,裘法祖,黄家驷.外科学[M].北京:人民卫生出版社,1999,482.
6.高尚社,杨宪煌.论中医药治疗食管癌的思路与方法[J].中医研究,2000,13(5):35.
7.白桦,李忠.食管癌的中西医结合诊治[J].中国临床医生杂志2000,35(4):527.
8.方卫东,化积散治疗食道咽下困难21例[J].湖北中医杂志.1997,19(1):30.
9.吴清都,等启膈汤治疗食道癌咽下困难症36例[J].福建中医药,1993,24(6):32,40.
10.王庆才,应用南星半夏汤加味缓解食管贲门癌梗阻[J].辽宁中医药杂志,1991,(1):27-28.
11.张书林,等中药治疗晚期食管癌31例[J].辽宁中医杂志,1989,14(5):23.
12.曾建军,吕仕银,任文烈.活血制癌汤治疗晚期食管癌38例疗效观察[J].现代中西医结合杂志,2004.13(20):2751.
13.柳建华,张正.自拟扶正消癌汤治疗晚期食道癌25例[J].四川中医,2008,26(1):82.
14.宋宝丽,三七噎膈散治疗食管癌咽下困难19例临床观察[J].河北中医,2007.29(9):801.
15.周浣贞,彭惠婷.针灸为主治疗晚期食道癌的临床观察[J].上海针灸杂志,1994,13(6):255-256.
16.魏刚,浅谈食管癌的按摩治验[J].按摩与导引,2006,22(7):17.
17.沈红,沈长兴.针刺天突治疗晚期食管癌吞咽困难120例[J]浙江中医杂志,1996,31(12):561.
18.王立冬,郑树.河南食管癌高发区人群食管癌贲门癌变机制[J].郑州大学学报(医学版),2002,37(6):717.
19.赵守华,赫捷.食管癌早期诊断的研究进展肿瘤[J].肿瘤,2008,28(2):177-178.
20.徐九如,徐家兴.重新评价胃肠道钡剂造影在现阶段的作用及任务[J].中华放射学杂志,1998,32(4):276-277.
21.张志庸,早期食管癌诊疗新进展[J/CD].中华临床医师杂志:电子版,2009,3(8):1231-1237.
22.陈识贤,实用放射学[M].第2版.北京:人民卫生出版社:2005,421-440.
23.Yang H,Berner A, Mei Q, et al. Cytologic screening for esophageal cancer in a high-risk population in Anyang County, China. Acta Cytol,2002,46(3):445-52.
24.Dawsey SM,YU Y,Taylor PR, et al. Esophageal cytology and subsequent risk of esophageal cancer. A prospective follow-up study from Linxian,China. Acta Cytol,1994,38(2):183-92.
25.景中军,食管癌的早期X线诊断[J].实用医技杂志,2006,13(12):2024.
26.朱亨礼,雷晓燕,刘辉,等.早期胃癌的X线表现于浸润深度相关性探讨[J].实用放射学杂志,2004,20(8):710-712.
27.郭永亮,食管癌X线钡餐造影与CT检查的对照分析[J].内蒙古中医药,2009,7:98.
28.李素娟,戴翠华.综合影像学检查对中晚期食管癌分期的意义[J].肿瘤研究与临床,2005,17(5):333-334.
29.Ponchon T,Makuuchi H,Morita Y,et al.Images of earlycancer:esophageal squamous-cell carcinoma[J].Endoscopy,2004,36(9):811-820.
30.Inoue H,High-magnification endoscopic diagnosis of su-perficial esophageal cancer[J].Digest Endosc,2000,12:32-35.
31.Kuznetsov KR.Lambert.et al.Narrow-band imaging : poten-tial and limitations[J].Endoscopy,2006,38:76-81.
32.Goda KI,Tajiri H,Kaise M,et al.Flat and small squa-mous cell carcinoma of the esophagus detection and diag-nosed by endoscopy with narrow-band imaging system[J].Digest Endosc,2006,18:9-12.
33.李延青,郭玉婷.共聚焦激光显微内镜在消化道疾病诊断中的应用[J].中华消化杂志,2007,27(2):140-141.
34.邵令方,王其新主编.新编食管外科学[M].河北科学技术出版社,石家庄,2002:59-75.
35.李辉,现代食管外科学[M].人民军医出版社,北京,2004:350-355.
36.邵令方,食管癌外科治疗概述.河南医学院主编,食管癌,人民卫生出版社,北京,1983:114.
37.Ruol A,Cstom C,Portale G et al,Tmnds in managment and pmgnosis for esophageal Surgery cancer twenty-five years of experience at a single institution.Arch Surg 2009 Mar;144(3):247-254.
38.Mehran RJ,Minimally invasive surgJcat treatment of esophageal carcinoma Gsatrointest caneer res.2008 Nov 2(6):283-286.
39.Minsky BD,Pajak TF,Ginsberg RJ,et a1.INT0123(Radiation Therapy Oncology Group 94-05)phaseⅢtrial of comhinedmodality therapy for esophageal cancer:higlldose versus standarddose radiation therapy.J Clin Onco,2002,20(5):1167-1174.
40.夏李明,陈奇勋,周星明,等.胸段食管癌喉返神经旁淋巴结转移的影响因素.中国肿瘤,2006,15(11):782-784.
41.Peracchia A,Rnol A,Bardini R,et al,Cam:er of the Thoracic Esophagus:What Is an Adequate Lymphadenectomy? Dig Surg 1993,10:141-145.
42.张蕾,王贵齐.早期食管癌及其癌前病变食管黏膜切除术[J].中国消化内镜,2007,1(1):4-6.
43.王贵齐,魏文强,郝长青.内镜下应用氩离子血浆凝固术治疗早期食管癌及其癌前病变的临床研究[J].中华消化内镜杂志,2004,21(6):365-367.
44.Wu KL,Tsao WL,Shyu KY.Lower-power laser therapy for gastrointestinal neoplasia[J].J Gastroenterol,2000,35(7):518-523.
45.毛永平,胃镜下钬激光气化切切除术治疗早期食管癌[J].中国消化内镜,2007,1(1):7-9.
46.Barr H,Kendall C,Stone N.Photodynamic therapy for esophageal cancer:a useful and realistic option[J].Technol Cancer Res Treat,2003,2(1):65-76.
47.Corti L,Skarlatus J,Beso C,et al.Outcome of patients receiving photodynamictherapy for early esophageal cancer[J].Int J Radiat Oncol Biol Plays,2000,47(2):419-424.
48.张彦周,冯义柏,黄恺.蝙蝠葛碱对心肌去甲肾上腺素出胞释放的影响[J].中国药理学通报,1998,14(1):45-47.
49.陈淑娟,杨毅梅,刘奕明.蝙蝠葛碱大鼠体内药物代谢动力学研究[J].中国药理学通报,2001,17(2):225-233.
50.朱接全,潘铁成,曾繁典.蝙蝠葛碱和利多艮因对人心房和兔房室结细胞动作电位及窦房结功能的影响[J].中国药理学与毒理学杂志,1990,4(4):244.
51.郭东林,夏敬生,顾世芬.蝙蝠葛碱对奎尼丁诱发的豚鼠乳头肌早后去极化及触发活动的作用[J].中国药理学与毒理学杂志,1998,12(4):253-255.
52.王福林,中西医结合治疗中晚期食管癌54例[J].中国中西医结合杂志,1997,17(4):253.
53.Muller JM, Erasmi H, StelznerM,et al. Surgical therapy of esophageal carcinoma[J].Br J Surg, 1990,77:845.
54.汤钊猷,现代肿瘤学[M].上海:上海医科大学出版社,2000:676.
55.严仲瑜,万远廉.消化道肿瘤外科学[M].北京:北京大学医学出版社,2003:181, 147-148.
56.焦小龙,周叔恭,严保国,等.食管癌切除胃代食管三种术式比较分析[J].肿瘤防治研究,1998,25(6):482-483.
57.陈少湖,安丰山.现代食管癌喷门癌诊疗学[M].北京:科学出版社,2002:157.
58.潘铁成,邱雪峰,李军.器械吻合与手工吻合在食管癌手术中的对比分析[J]中国胸心血管外科临床杂志,2005,(04):102.
59.张庆斌,周佐涛,蓝俊等.中西医结合治疗食管癌切除术后吻合口屡9例[J].河北中医,2001.23(3):218.
60.杨迅,刘金石等.185例70岁以上老年人食管癌的外科治疗[J].肿瘤学杂志,2009,15(4):327.
61.王者生,食管癌贲门癌临床[M].沈阳:辽宁大学出版社,1993:98.
62.杨建平,张德荣,李林.食管癌术后心律失常临床分析[J].福建医科大学学报,2004,38(2):199-201.
63.Ahn H J a,Sim W S a,Shim Y M,et al.Thoracicepidural anesthesia does notimprove the incidence ofarrhythmias after transthoracic esophagectomy[J].European Journal of Cardio-Thoracic Surgery,2005,28(1):19-21.
64.周汝元,于在诚,葛圣林.胸外科非心脏手术后心血管并发症32例分析[J].中华胸心血管外科杂志,1995,11(4):210.
65.毛中鹏,侯东祥,李建辉.食管癌术后应用平消胶囊替代化疗的疗效观察[J].现代肿瘤医学,2004,12(1):57.
66.董光同,高元兴,蒋成榜.参一胶囊辅治老年食管癌切除后疗效观察[J].浙江中西医结合杂志,2007,17(1):39.
67.王景祥,梁涛,徐英纳.益气通腑汤在食管贲门癌术后的早期应用[J].中国中西医结合外科杂志,2005,11(3):259-260.
2. Pisani P,Parkin DM,Bray F,et a1.Estimates of the world wide mortality from 25 cancers in 1990[J].Int J Cancer,1999,83:18-29.
3.灏珠,实用内科学下册[M].北京:人民卫生出版社,2003:1721.
4.吴在德,吴肇汉,郑树.外科学[M].北京:人民卫生出版社,2005,368.
5.吴阶平,裘法祖,黄家驷.外科学[M].北京:人民卫生出版社,1999,482.
6.高尚社,杨宪煌.论中医药治疗食管癌的思路与方法[J].中医研究,2000,13(5):35.
7.白桦,李忠.食管癌的中西医结合诊治[J].中国临床医生杂志2000,35(4):527.
8.方卫东,化积散治疗食道咽下困难21例[J].湖北中医杂志.1997,19(1):30.
9.吴清都,等启膈汤治疗食道癌咽下困难症36例[J].福建中医药,1993,24(6):32,40.
10.王庆才,应用南星半夏汤加味缓解食管贲门癌梗阻[J].辽宁中医药杂志,1991,(1):27-28.
11.张书林,等中药治疗晚期食管癌31例[J].辽宁中医杂志,1989,14(5):23.
12.曾建军,吕仕银,任文烈.活血制癌汤治疗晚期食管癌38例疗效观察[J].现代中西医结合杂志,2004.13(20):2751.
13.柳建华,张正.自拟扶正消癌汤治疗晚期食道癌25例[J].四川中医,2008,26(1):82.
14.宋宝丽,三七噎膈散治疗食管癌咽下困难19例临床观察[J].河北中医,2007.29(9):801.
15.周浣贞,彭惠婷.针灸为主治疗晚期食道癌的临床观察[J].上海针灸杂志,1994,13(6):255-256.
16.魏刚,浅谈食管癌的按摩治验[J].按摩与导引,2006,22(7):17.
17.沈红,沈长兴.针刺天突治疗晚期食管癌吞咽困难120例[J]浙江中医杂志,1996,31(12):561.
18.王立冬,郑树.河南食管癌高发区人群食管癌贲门癌变机制[J].郑州大学学报(医学版),2002,37(6):717.
19.赵守华,赫捷.食管癌早期诊断的研究进展肿瘤[J].肿瘤,2008,28(2):177-178.
20.徐九如,徐家兴.重新评价胃肠道钡剂造影在现阶段的作用及任务[J].中华放射学杂志,1998,32(4):276-277.
21.张志庸,早期食管癌诊疗新进展[J/CD].中华临床医师杂志:电子版,2009,3(8):1231-1237.
22.陈识贤,实用放射学[M].第2版.北京:人民卫生出版社:2005,421-440.
23.Yang H,Berner A, Mei Q, et al. Cytologic screening for esophageal cancer in a high-risk population in Anyang County, China. Acta Cytol,2002,46(3):445-52.
24.Dawsey SM,YU Y,Taylor PR, et al. Esophageal cytology and subsequent risk of esophageal cancer. A prospective follow-up study from Linxian,China. Acta Cytol,1994,38(2):183-92.
25.景中军,食管癌的早期X线诊断[J].实用医技杂志,2006,13(12):2024.
26.朱亨礼,雷晓燕,刘辉,等.早期胃癌的X线表现于浸润深度相关性探讨[J].实用放射学杂志,2004,20(8):710-712.
27.郭永亮,食管癌X线钡餐造影与CT检查的对照分析[J].内蒙古中医药,2009,7:98.
28.李素娟,戴翠华.综合影像学检查对中晚期食管癌分期的意义[J].肿瘤研究与临床,2005,17(5):333-334.
29.Ponchon T,Makuuchi H,Morita Y,et al.Images of earlycancer:esophageal squamous-cell carcinoma[J].Endoscopy,2004,36(9):811-820.
30.Inoue H,High-magnification endoscopic diagnosis of su-perficial esophageal cancer[J].Digest Endosc,2000,12:32-35.
31.Kuznetsov KR.Lambert.et al.Narrow-band imaging : poten-tial and limitations[J].Endoscopy,2006,38:76-81.
32.Goda KI,Tajiri H,Kaise M,et al.Flat and small squa-mous cell carcinoma of the esophagus detection and diag-nosed by endoscopy with narrow-band imaging system[J].Digest Endosc,2006,18:9-12.
33.李延青,郭玉婷.共聚焦激光显微内镜在消化道疾病诊断中的应用[J].中华消化杂志,2007,27(2):140-141.
34.邵令方,王其新主编.新编食管外科学[M].河北科学技术出版社,石家庄,2002:59-75.
35.李辉,现代食管外科学[M].人民军医出版社,北京,2004:350-355.
36.邵令方,食管癌外科治疗概述.河南医学院主编,食管癌,人民卫生出版社,北京,1983:114.
37.Ruol A,Cstom C,Portale G et al,Tmnds in managment and pmgnosis for esophageal Surgery cancer twenty-five years of experience at a single institution.Arch Surg 2009 Mar;144(3):247-254.
38.Mehran RJ,Minimally invasive surgJcat treatment of esophageal carcinoma Gsatrointest caneer res.2008 Nov 2(6):283-286.
39.Minsky BD,Pajak TF,Ginsberg RJ,et a1.INT0123(Radiation Therapy Oncology Group 94-05)phaseⅢtrial of comhinedmodality therapy for esophageal cancer:higlldose versus standarddose radiation therapy.J Clin Onco,2002,20(5):1167-1174.
40.夏李明,陈奇勋,周星明,等.胸段食管癌喉返神经旁淋巴结转移的影响因素.中国肿瘤,2006,15(11):782-784.
41.Peracchia A,Rnol A,Bardini R,et al,Cam:er of the Thoracic Esophagus:What Is an Adequate Lymphadenectomy? Dig Surg 1993,10:141-145.
42.张蕾,王贵齐.早期食管癌及其癌前病变食管黏膜切除术[J].中国消化内镜,2007,1(1):4-6.
43.王贵齐,魏文强,郝长青.内镜下应用氩离子血浆凝固术治疗早期食管癌及其癌前病变的临床研究[J].中华消化内镜杂志,2004,21(6):365-367.
44.Wu KL,Tsao WL,Shyu KY.Lower-power laser therapy for gastrointestinal neoplasia[J].J Gastroenterol,2000,35(7):518-523.
45.毛永平,胃镜下钬激光气化切切除术治疗早期食管癌[J].中国消化内镜,2007,1(1):7-9.
46.Barr H,Kendall C,Stone N.Photodynamic therapy for esophageal cancer:a useful and realistic option[J].Technol Cancer Res Treat,2003,2(1):65-76.
47.Corti L,Skarlatus J,Beso C,et al.Outcome of patients receiving photodynamictherapy for early esophageal cancer[J].Int J Radiat Oncol Biol Plays,2000,47(2):419-424.
48.张彦周,冯义柏,黄恺.蝙蝠葛碱对心肌去甲肾上腺素出胞释放的影响[J].中国药理学通报,1998,14(1):45-47.
49.陈淑娟,杨毅梅,刘奕明.蝙蝠葛碱大鼠体内药物代谢动力学研究[J].中国药理学通报,2001,17(2):225-233.
50.朱接全,潘铁成,曾繁典.蝙蝠葛碱和利多艮因对人心房和兔房室结细胞动作电位及窦房结功能的影响[J].中国药理学与毒理学杂志,1990,4(4):244.
51.郭东林,夏敬生,顾世芬.蝙蝠葛碱对奎尼丁诱发的豚鼠乳头肌早后去极化及触发活动的作用[J].中国药理学与毒理学杂志,1998,12(4):253-255.
52.王福林,中西医结合治疗中晚期食管癌54例[J].中国中西医结合杂志,1997,17(4):253.
53.Muller JM, Erasmi H, StelznerM,et al. Surgical therapy of esophageal carcinoma[J].Br J Surg, 1990,77:845.
54.汤钊猷,现代肿瘤学[M].上海:上海医科大学出版社,2000:676.
55.严仲瑜,万远廉.消化道肿瘤外科学[M].北京:北京大学医学出版社,2003:181, 147-148.
56.焦小龙,周叔恭,严保国,等.食管癌切除胃代食管三种术式比较分析[J].肿瘤防治研究,1998,25(6):482-483.
57.陈少湖,安丰山.现代食管癌喷门癌诊疗学[M].北京:科学出版社,2002:157.
58.潘铁成,邱雪峰,李军.器械吻合与手工吻合在食管癌手术中的对比分析[J]中国胸心血管外科临床杂志,2005,(04):102.
59.张庆斌,周佐涛,蓝俊等.中西医结合治疗食管癌切除术后吻合口屡9例[J].河北中医,2001.23(3):218.
60.杨迅,刘金石等.185例70岁以上老年人食管癌的外科治疗[J].肿瘤学杂志,2009,15(4):327.
61.王者生,食管癌贲门癌临床[M].沈阳:辽宁大学出版社,1993:98.
62.杨建平,张德荣,李林.食管癌术后心律失常临床分析[J].福建医科大学学报,2004,38(2):199-201.
63.Ahn H J a,Sim W S a,Shim Y M,et al.Thoracicepidural anesthesia does notimprove the incidence ofarrhythmias after transthoracic esophagectomy[J].European Journal of Cardio-Thoracic Surgery,2005,28(1):19-21.
64.周汝元,于在诚,葛圣林.胸外科非心脏手术后心血管并发症32例分析[J].中华胸心血管外科杂志,1995,11(4):210.
65.毛中鹏,侯东祥,李建辉.食管癌术后应用平消胶囊替代化疗的疗效观察[J].现代肿瘤医学,2004,12(1):57.
66.董光同,高元兴,蒋成榜.参一胶囊辅治老年食管癌切除后疗效观察[J].浙江中西医结合杂志,2007,17(1):39.
67.王景祥,梁涛,徐英纳.益气通腑汤在食管贲门癌术后的早期应用[J].中国中西医结合外科杂志,2005,11(3):259-260.