经腹与经胸入路手术对贲门癌患者术后相关肺部并发症的临床研究

发布时间：2018-02-09 06:48

本文关键词： 贲门癌术后肺部并发症经腹入路经胸入路　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景贲门癌是常见的消化道肿瘤,是发生于胃贲门粘膜上皮及贲门腺体,肿瘤中心位于食管与胃结合部2-3cm内的腺癌。因贲门的特殊解剖位置与肿瘤生物学特征,手术是贲门癌的首选治疗,但几十年来贲门癌的手术入路始终无统一模式,人们在做多种径路尝试,而经胸、经腹是目前临床最常见的两种手术入路形式,但其优劣及选择时机在临床工作及各研究报道中存在较多的争议,而两种入路的5年生存率并不存在显著差异。本研究回顾性分析了我院2006年1月至2015年1月收治的174例贲门癌患者,按经腹、经胸的手术入路分为经腹组和经胸组,拟探讨两种手术入路在疗效、并发症及对患者预后影响等方面的优劣,特别是将研究重心放在术后肺部并发症的分析上,以期从近期疗效及经济性方面评价两种入路手术,对临床上治疗贲门癌患者规范化的选择手术入路及尽可能的避免术后相关肺部并发症的发生提供理论依据。目的.探讨不同手术入路对贲门癌患者预后及术后相关肺部并发症的影响,为合理的规范化的选择贲门癌根治术手术路径提供参考依据。方法回顾性分析了我院2006年1月至2015年1月收治的174例贲门癌患者,按经腹、经胸的手术入路分为经腹组和经胸组,其中经胸组98人接受经左胸入路的贲门癌根治术而经腹组76人接受经腹入路的根治术,分析两组围手术期及术后相关指标(手术时间,术中出血量,住院时间,术中淋巴清扫结数,切缘癌残留阳性率,治疗费用,术后1d、3d视觉疼痛模拟评分(visual analogue scale,VAS),术后1d内芬太尼用量,术后1d内心率异常变化及血压异常变化例数,1年生存率,2年生存率,1年内复发或转移发生率;并分析两组术后相关肺部并发症(肺部感染,肺不张,胸腔积液,脓胸,急性呼吸窘迫综合征,呼吸衰竭)及其它并发症发生情况(吻合口瘘,吻合口狭窄,反流性食管炎,切口感染,腹腔感染,心律失常)。结果(1)经胸组手术时间、术中出血量、住院时间、治疗费用,术后PCIA芬太尼用量及术后1d和3d的VAS评分均显著多于经腹组,差异有统计学意义(P0.05)。(2)术后经胸组心率和血压的异常变化发生率及1年生存率分别为13.27%,11.22%,74.49%,与经腹组2.63%,2.63%,86.84%有显著差异,差异具有统计学意义(P0.05)。(3)术后经腹组在肺部感染、胸腔积液、脓胸等肺部并发症的发生例数上显著低于经胸组,差异有统计学意义(P0.05)。(4)术后经腹组在吻合口瘘,吻合口狭窄,反流性食管炎,切口感染,腹腔感染,心律失常并发症的发生例数上差异无统计学意义(P0.05)。结论对于贲门癌患者,术前应先行上消化道造影(钡餐或碘油造影)、增强CT明确肿瘤病变范围,特别对于基础情况较差的患者,首选经腹入路手术,若病变累及下段食管1-3cm,全身情况尤其心肺功能允许的前提下,可先经腹入路探查,必要时联合胸部切口完成手术。术前充分评估患者病情,尽量避免经胸入路完成手术,以免造成患者术后相关肺部并发症及影响预后,如果患者病灶较大或侵犯食道3cm以上,心肺功能许可条件下,可直接经胸入路手术。
[Abstract]:Background cardiac carcinoma is a common gastrointestinal tumor, occurs in gastric mucosa and gastric cardia gland cancer center in esophagus and gastric junction adenocarcinoma in 2-3cm. Due to the special anatomical position and biological characteristics of cardiac tumor, surgery is the preferred treatment of cardia cancer, but decades of cardia cancer surgical approach no unified mode, people in various approaches attempt, and transthoracic and transabdominal is the most common clinical two surgical approaches, but its quality and timing is controversial in clinical work and research reports, and the two 5 year survival rate approach did not differ significantly the difference in this study. A retrospective analysis of 174 cases of cardiac cancer patients in our hospital from January 2006 to January 2015, according to the transabdominal, transthoracic approach group divided into transabdominal and transthoracic group, to investigate the two surgical approaches in efficacy, and complications in patients with pre The good and bad aspects after effects, especially the research emphasis on the analysis of postoperative pulmonary complications, in order of two operative approaches from the recent efficacy and economic evaluation, to regulate the cardiac cancer patients of approach and avoid as much as possible and provide a theoretical basis related to postoperative pulmonary complications the clinical treatment. Objective. To explore different approaches for influencing the prognosis of patients of pulmonary complications and cardiac carcinoma after operation, and provide reference for reasonable selection of standardized cardia cancer radical surgery path. Methods a retrospective analysis of 174 cases of cardiac cancer patients in our hospital from January 2006 to January 2015, according to the abdomen, transthoracic approach consists of transabdominal and transthoracic group group, the group of 98 people undergoing percutaneous transthoracic left thoracic approach of radical resection of cardiac carcinoma and abdominal group 76 underwent transabdominal radical surgery, analysis of two groups during the perioperative period Related index and postoperative (operation time, amount of bleeding, hospitalization time, intraoperative lymph nodes, residual cancer positive rate, the cost of treatment, postoperative 1D, 3D visual analogue score (visual analogue, scale, VAS), 1D postoperative dosage of fentanyl, and the abnormal changes of blood pressure and heart rate 1D after the abnormal changes of the number of cases, the 1 year survival rate, survival rate of 2 years, 1 years recurrence or metastasis rate; and analysis of two groups of postoperative pulmonary complications (pulmonary infection, atelectasis, pleural effusion, empyema, acute respiratory distress syndrome, respiratory failure and other complications (occurrence) anastomotic fistula, anastomotic stenosis, reflux esophagitis, incision infection, intra-abdominal infection, arrhythmia). Results (1) transthoracic group operation time, intraoperative bleeding, hospitalization time, cost of treatment, postoperative fentanyl consumption of PCIA and 1D after operation and 3D VAS scores were significantly higher than transabdominal there were significant differences between the groups. Meaning (P0.05). (2) the incidence rate and 1 year survival rates were 13.27%, 11.22%, 74.49% abnormal changes in transthoracic group heart rate and blood pressure after surgery and abdominal group 2.63%, 2.63%, 86.84% there is a significant difference, the difference was statistically significant (P0.05). (3) after operation in abdominal group pulmonary infection, pleural effusion, the incidence of pulmonary complications of empyema was significantly lower than transthoracic group, the difference was statistically significant (P0.05). (4) postoperative abdominal group in anastomotic fistula, anastomotic stenosis, reflux esophagitis, incision infection, intra-abdominal infection, the number of cases of different rhythm arrhythmia complications had no statistical significance (P0.05). Conclusion for patients with cardiac cancer, preoperative should first upper gastrointestinal radiography (barium or iodine oilradiography), enhanced CT clear tumor lesion, especially for the basic situation of the patients, the preferred surgical transabdominal approach, if the lesions involving the lower esophageal body 1-3cm. Especially the heart lung The premise of function permits, the first transabdominal probe, when necessary, combined with thoracic incision operation. Preoperative assessment of the patient's condition, try to avoid the thoracic surgery, so as to avoid related pulmonary complications and prognostic patients, if patients with large lesions or invasion of esophageal 3cm, condition of heart and lung function permit, direct the thoracic surgery.

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

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