Aceto Paola, Congedo Elisabetta, Cardone Alexander, Zappia Luca, De Cosmo Germano
Istituto di Anestesiologia e Rianimazione, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy.
Rays. 2005 Oct-Dec;30(4):289-94.
Postoperative management after elective esophagectomy for cancer has not been standardized. Thoracoabdominal incision with associated pain, extended operative time with consequent extracellular fluid shifts, single lung ventilation, potential for prolonged postoperative mechanical ventilation and comorbidities in patients with esophageal cancer, all contribute to high perioperative risk. Respiratory problems remain the major cause of both mortality and morbidity after esophagectomy for cancer. A specific pulmonary disorder, acute respiratory distress syndrome (ARDS) occurs in 10-20% of patients after esophagectomy. ARDS mortality exceeds 50%. Atrial fibrillation, that complicates recovery in 20 to 25% of patients after esophagectomy, contributes to make outcome worse. Anesthesiologists should adopt strategies known to be able to optimize patient outcome. Decreased postoperative mortality and morbidity have been associated with epidural analgesia, bronchoscopy to clear persistent bronchial secretions, intraoperative fluid restriction and early extubation. It has been shown that setting up early respiratory physiotherapy and mobilitation may improve functional recovery.
择期食管癌切除术后的管理尚未标准化。胸腹联合切口伴有疼痛、手术时间延长导致细胞外液转移、单肺通气、食管癌患者术后机械通气时间可能延长以及合并症等，均导致围手术期风险较高。呼吸问题仍然是食管癌切除术后死亡率和发病率的主要原因。一种特定的肺部疾病——急性呼吸窘迫综合征（ARDS）在食管癌切除术后的患者中发生率为10% - 20%。ARDS的死亡率超过50%。心房颤动使20%至25%的食管癌切除术后患者恢复过程复杂化，导致预后更差。麻醉医生应采用已知能够优化患者预后的策略。术后死亡率和发病率的降低与硬膜外镇痛、支气管镜检查以清除持续的支气管分泌物、术中液体限制和早期拔管有关。研究表明，早期开展呼吸物理治疗和活动可能改善功能恢复。
