本文關(guān)鍵詞： 賁門癌 術(shù)后肺部并發(fā)癥 經(jīng)腹入路 經(jīng)胸入路　出處：《南方醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：背景賁門癌是常見的消化道腫瘤,是發(fā)生于胃賁門粘膜上皮及賁門腺體,腫瘤中心位于食管與胃結(jié)合部2-3cm內(nèi)的腺癌。因賁門的特殊解剖位置與腫瘤生物學特征,手術(shù)是賁門癌的首選治療,但幾十年來賁門癌的手術(shù)入路始終無統(tǒng)一模式,人們在做多種徑路嘗試,而經(jīng)胸、經(jīng)腹是目前臨床最常見的兩種手術(shù)入路形式,但其優(yōu)劣及選擇時機在臨床工作及各研究報道中存在較多的爭議,而兩種入路的5年生存率并不存在顯著差異。本研究回顧性分析了我院2006年1月至2015年1月收治的174例賁門癌患者,按經(jīng)腹、經(jīng)胸的手術(shù)入路分為經(jīng)腹組和經(jīng)胸組,擬探討兩種手術(shù)入路在療效、并發(fā)癥及對患者預后影響等方面的優(yōu)劣,特別是將研究重心放在術(shù)后肺部并發(fā)癥的分析上,以期從近期療效及經(jīng)濟性方面評價兩種入路手術(shù),對臨床上治療賁門癌患者規(guī)范化的選擇手術(shù)入路及盡可能的避免術(shù)后相關(guān)肺部并發(fā)癥的發(fā)生提供理論依據(jù)。目的.探討不同手術(shù)入路對賁門癌患者預后及術(shù)后相關(guān)肺部并發(fā)癥的影響,為合理的規(guī)范化的選擇賁門癌根治術(shù)手術(shù)路徑提供參考依據(jù)。方法回顧性分析了我院2006年1月至2015年1月收治的174例賁門癌患者,按經(jīng)腹、經(jīng)胸的手術(shù)入路分為經(jīng)腹組和經(jīng)胸組,其中經(jīng)胸組98人接受經(jīng)左胸入路的賁門癌根治術(shù)而經(jīng)腹組76人接受經(jīng)腹入路的根治術(shù),分析兩組圍手術(shù)期及術(shù)后相關(guān)指標(手術(shù)時間,術(shù)中出血量,住院時間,術(shù)中淋巴清掃結(jié)數(shù),切緣癌殘留陽性率,治療費用,術(shù)后1d、3d視覺疼痛模擬評分(visual analogue scale,VAS),術(shù)后1d內(nèi)芬太尼用量,術(shù)后1d內(nèi)心率異常變化及血壓異常變化例數(shù),1年生存率,2年生存率,1年內(nèi)復發(fā)或轉(zhuǎn)移發(fā)生率;并分析兩組術(shù)后相關(guān)肺部并發(fā)癥(肺部感染,肺不張,胸腔積液,膿胸,急性呼吸窘迫綜合征,呼吸衰竭)及其它并發(fā)癥發(fā)生情況(吻合口瘺,吻合口狹窄,反流性食管炎,切口感染,腹腔感染,心律失常)。結(jié)果(1)經(jīng)胸組手術(shù)時間、術(shù)中出血量、住院時間、治療費用,術(shù)后PCIA芬太尼用量及術(shù)后1d和3d的VAS評分均顯著多于經(jīng)腹組,差異有統(tǒng)計學意義(P0.05)。(2)術(shù)后經(jīng)胸組心率和血壓的異常變化發(fā)生率及1年生存率分別為13.27%,11.22%,74.49%,與經(jīng)腹組2.63%,2.63%,86.84%有顯著差異,差異具有統(tǒng)計學意義(P0.05)。(3)術(shù)后經(jīng)腹組在肺部感染、胸腔積液、膿胸等肺部并發(fā)癥的發(fā)生例數(shù)上顯著低于經(jīng)胸組,差異有統(tǒng)計學意義(P0.05)。(4)術(shù)后經(jīng)腹組在吻合口瘺,吻合口狹窄,反流性食管炎,切口感染,腹腔感染,心律失常并發(fā)癥的發(fā)生例數(shù)上差異無統(tǒng)計學意義(P0.05)。結(jié)論對于賁門癌患者,術(shù)前應(yīng)先行上消化道造影(鋇餐或碘油造影)、增強CT明確腫瘤病變范圍,特別對于基礎(chǔ)情況較差的患者,首選經(jīng)腹入路手術(shù),若病變累及下段食管1-3cm,全身情況尤其心肺功能允許的前提下,可先經(jīng)腹入路探查,必要時聯(lián)合胸部切口完成手術(shù)。術(shù)前充分評估患者病情,盡量避免經(jīng)胸入路完成手術(shù),以免造成患者術(shù)后相關(guān)肺部并發(fā)癥及影響預后,如果患者病灶較大或侵犯食道3cm以上,心肺功能許可條件下,可直接經(jīng)胸入路手術(shù)。
[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.

【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735

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