合并心肺疾病老年胃癌患者的围手术期处理

摘要

目的 总结合并心肺疾病的老年胃癌患者的围手术期处理方法. 方法 回顾性分析我院于2002年3月～2009年8月期间收治的150例合并心肺疾病的老年胃癌患者的围手术期处理的临床资料,其中合并心血管疾病77例(51.3％),合并呼吸系统疾病43例(28.7％),同时合并这两种疾病者30例(20.0％).TNM分期为:Ⅰ期者3例,Ⅱ期11例,Ⅲ期106例,Ⅳ期30例. 结果 所有患者均顺利完成手术,无术中死亡病例.术后发生并发症共48例(32.0％),其中肺部感染16例,切口液化及感染12例,返流性食管炎10例,胃瘫3例,输出襻不全梗阻2例,吻合口出血1例,十二指肠残端瘘1例,腹腔出血1例,急性胰腺炎1例,急性心肌梗塞1例.围手术期死亡8例,包括心肺功能衰竭6例、DIC 1例、急性心肌梗塞1例. 结论 合并心肺疾病时老年胃癌患者的手术风险较大.针对合并疾病进行正确而合理的围手术期处理,既可降低手术风险,也能减少手术并发症的发生率和围手术期的死亡率.%Objective To summary the perioperative managements of aged gastric cancer patients combined cardiopulmonary comorbidity. Methods The clinical data of perioperative managements for 150 elderly gastric cancer patients coexisting cardiopulmonary diseases treated in our hospital from March 2002 to August 2009 were analyzed retrospectively. Among them, 77 cases (51. 3% ) were combined cardiovascular diseases and 43 cases (28, 6% ) were combined pulmonary diseases, and 30 cases (20. 0% ) were combined both diseases. There were stage Ⅰ in 3 cases, stage Ⅱ in 11 cases, stage Ⅲ in 106 cases and stage IV in 30 cases according to TNM staging. Results All 150 cases were performed surgical treatment without intraoperative death. There were 48 cases of main postoperative complications, including 16 cases of pulmonary infection, 12 cases of liquefied incision infection, 10 cases of reflux esophagitis, 3 cases of gastroplegia, 2 cases of partial obstruction of export loop, 1 case of anastomotic bleeding, 1 case of duodenal stump fistula, 1 case of abdominal hemorrhage, 1 case of acute pancreatitis and 1 case of acute myocardia infarction. Eight patients died during perioperative period; 6 died of cardiorespiratory function failure, 1 of disseminated intravascular coagulopathy ( DIC) and 1 of acute myocardial infarction. Conclusions Cardiopulmonary comorbidity can increase the operative risk of elderly patients with gastric caner. The exact and reasonable perioperative managements for cardiopulmonary comorbidity not only can reduce the risk of operation, but also decrease the,incidence of operative complication and perioperative mortality.