胸部食道癌根治術施行症例の患者管理の検討 : 特にPoor Riskの基準に就いて
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The radical operation for the thoracic esophageal cancer, simulataneous thoracoabdominal approach, is one of the largest surgical operation, but recently this operation have been done safely by the advanced anesthesiology, chemotherapy and the good management of the patients. However, almost all patients undergoing surgery for esophageal cancer, have old aged, lost weight, may have nutritional defficiency, and combined the cardiac, lung, and kidney damages. Anesthesiologicaly, author did several observations, C.B.C., E.C.G., lung-function, lever-function, kidney-function and so on, also researched that relationship, which the preoperative conditions influence to the operative and postoperative course, in 322 cases since 1952 to 1957. 6 at Nakayama's Surgical Department. 1) All of the patients who were performed the radical operation of the thoracic esophageal cancer, have been evaluated into several classes, normal, mild, moderate, and severe damaged conditions. Then divided them by my "STANDARD OF THE POOR RISK", 63.9% of this cases are in poor risk conditions : aged (13.0 %), anemic (28.8 %), mal-nutrition (48.7 %), cardiac damaged (14.0%), pulmonar damaged (14.6%), hepatic damaged (17.8%), and renal damaged (7.1 %). 2) Concerning of the operative course, especially blood pressure change, compared between normal and poor risk cases. The marked blood pressur falls had been showed in the anemic, mal-nutrition, cardiac damaged and pulmonar damaged cases. And the influences of the anesthetic technique had showed no differences between the generalspinal combined anesthesia. 3) Postoperative courses, concerning the occurrences of the postoperative pulmonary complication (P.P.C), P.P.C. did occured 31.1% in all of this cases. Every poor risk cases increasing occurrences of the P.P.C.; especially aged (46.3 %), mal-nutrition (44.4 %), cardiac damaged (44.4 %), pulmonar damaged (44.7 %), hepatic damaged (50.0 %), renal damaged (82.6 %) and cardiac damaged cases with combined pulmonar damage had been occurred marked increased P. P. C. (75.0 %). 4) Author emphasized that the necessity of the goog management of the poor risk patients, and tracheotomy for the P. P. C. actively if necessary, author did tracheotomy preoperatively for wet lung cases. Concerning P.P.C. compared the general anesthesia with general-spinal combined anesthesia for that poor risk patients, the occurrences of the P. P. C. had been increased in the general anesthesia than the general-spinal combined anesthesia for the poor risk patients (40.8:22.0), especially aged (47.3:27.3), anemic (40.6:13.1), cardiac damaged (65.0:28.0), pulmonar damaged (62.5:26.0), however the hepatic damaged and renal damaged showed no differences between them.
- 千葉大学の論文
- 1958-09-28
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