Ye Y, Wang D, Shao C
Department of Thoracic Cardiovascular Surgery, 81st Hospital of People's Liberation Army, Nanjing.
Zhonghua Wai Ke Za Zhi. 1997 Jun;35(6):364-6.
For patients with chest cancer who are in advanced stage, aged, or/and with respiratory insufficiency, the key to the success of open-chest surgery is intensive management of the respiratory tract and proper treatment of complications in perioperative period. From May 1984 to November 1995, 1661 patients with esophageal and lung cancer underwent thoracotomy in our hospital. 198 of the 1661 patients fit in with the standards of advanced, aged or respiratory insufficiency. The patients were aged over 70 years, with the length of esophageal cancer over 10 cm and, the MVV less than 50% (least 24.3%). The results the patients were satisfactory because a series of the effective measures of perioperative management were tahen. They incladed thyrocrico-puncture and use of a fine tube through which drugs were injected to irritate cough sputum out; examination and suction with bronchofiberoscope; tracheo-bronchial lavage through bronchofiberoscope with antibiotics solution; and tracheotomy using ventilator appropriately. Perioperative intensive management is very important for extending operation indication and tiding over critical period.
对于晚期、高龄或/且伴有呼吸功能不全的胸段癌患者，开胸手术成功的关键在于围手术期对呼吸道的强化管理及并发症的妥善处理。1984年5月至1995年11月，我院有1661例食管癌和肺癌患者接受了开胸手术。1661例患者中有198例符合晚期、高龄或呼吸功能不全标准。这些患者年龄超过70岁，食管癌长度超过10 cm，最大通气量（MVV）小于50%（至少为24.3%）。由于采取了一系列有效的围手术期管理措施，患者的治疗效果令人满意。这些措施包括环甲膜穿刺并使用细管注入药物以刺激咳出痰液；用纤维支气管镜检查和吸痰；通过纤维支气管镜用抗生素溶液进行气管支气管灌洗；以及适时使用呼吸机进行气管切开。围手术期强化管理对于扩大手术适应证和度过危险期非常重要。
