Liedman B L, Bennegård K, Olbe L C, Lundell L R
Department of Surgery, Sahlgren's Hospital, University of Gothenburg, Sweden.
Eur J Surg. 1995 Mar;161(3):173-80.
To define risk factors for postoperative morbidity and mortality in patients undergoing standardised laparotomy/gastrectomy or thoracoabdominal resection for carcinomas of the stomach, oesophagus, and oesophagogastric junction.
Prospective open study.
University hospital, Sweden.
All 213 patients operated on for carcinoma of the stomach, oesophagus, or oesophagogastric junction between January 1983 and June 1990.
Laparotomy/gastrectomy (n = 132) or thoracoabdominal resection (n = 81).
Postoperative morbidity and mortality.
8 Patients died after laparotomy/gastrectomy, and 10 after thoracoabdominal resection. Complications were more common after thoracoabdominal resection (101 in 81 patients) than after laparotomy/gastrectomy (108 in 132 patients). The most common complication in both groups was pneumonia (29/132, 22%, compared with 22/81, 27%), but this could be predicted only in the group that underwent thoracoabdominal resection. Significant risk factors in this group were: an abnormal chest radiograph preoperatively (p = 0.0007), a high risk predicted by the anaesthetist (p = 0.005), and signs of obstruction on spirometry (p = 0.002). In the thoracoabdominal group a history of pulmonary disease, the patient's age, and general physical performance assessed by the exercise test significantly predicted a high risk of postoperative death. Risk profile curves for mortality were generated for patients aged 55, 65, or 75 years with and without pre-existing pulmonary disease and adjusted for working capacity (W) so that patients at high risk of dying after thoracoabdominal resection could easily be identified. Any patient with a history of pulmonary disease and a working capacity of less than 80 W whatever their age should be advised against thoracoabdominal resection, whereas in those without a history of pulmonary disease and a working capacity of more than 80 W, a good recovery may be anticipated. The cut off point for working capacity seems to be 80 W.
With simple clinical guidelines it is possible to draw risk profiles for patients about to undergo thoracoabdominal resections for carcinoma of the oesophagus or oesophagogastric junction.
确定接受标准化剖腹术/胃切除术或胸腹联合切除术治疗胃癌、食管癌及食管胃交界部癌患者术后发病和死亡的危险因素。
前瞻性开放性研究。
瑞典的大学医院。
1983年1月至1990年6月间所有因胃癌、食管癌或食管胃交界部癌接受手术治疗的213例患者。
剖腹术/胃切除术（n = 132）或胸腹联合切除术（n = 81）。
术后发病率和死亡率。
剖腹术/胃切除术后8例患者死亡，胸腹联合切除术后10例患者死亡。胸腹联合切除术后并发症（81例患者中有101例）比剖腹术/胃切除术后（132例患者中有108例）更常见。两组最常见的并发症均为肺炎（132例中的29例，22%，相比81例中的22例，27%），但仅在接受胸腹联合切除术的组中可预测。该组的显著危险因素为：术前胸部X线片异常（p = 0.0007）、麻醉师预测的高风险（p = 0.005）以及肺量计检查有梗阻迹象（p = 0.002）。在胸腹联合切除组中，肺部疾病史、患者年龄以及通过运动试验评估的总体身体状况显著预测术后死亡的高风险。针对年龄为55岁、65岁或75岁且有或无既往肺部疾病的患者生成了死亡率风险曲线，并根据工作能力（W）进行了调整，以便能够轻松识别胸腹联合切除术后有高死亡风险的患者。任何有肺部疾病史且工作能力低于80W的患者，无论其年龄如何，均应建议不进行胸腹联合切除术，而对于无肺部疾病史且工作能力超过80W的患者，可预期有良好的恢复。工作能力的临界值似乎为80W。
通过简单的临床指南，有可能为即将接受食管癌或食管胃交界部癌胸腹联合切除术的患者绘制风险曲线。
