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目的 为了探讨食管和贲门癌伴发窦性心动过缓可能原因及手术有关问题。方法 总结1987年6月～1997年5月间。伴有窦缓的食管及贲门癌88例,均经阿托品试验证实为迷走神经张力增高者为95.5％,与同期不伴有窦缓的食管,贲门癌785例对照分析,其病变长度、侵润深度及淋巴结转移和手术切除率情况比较。结果 窦缓组大多为肿瘤中晚期患者,其病变长度和侵润程度与对照组比较差异显著(P<0.05),手术切除率低(P<0.01)。而且手术切除比单纯探查者术后心率明显增加(P<0.01),无手术死亡。结论 食管及贲门癌伴有窦缓者可能是肿瘤对迷走神经的侵润性牵拉或压迫所致,这部分患者多系肿瘤中晚期,术前应详尽检查,避免不必要的开胸探查。
Objective To investigate the possible causes of sinus bradycardia associated with esophageal and cardiac cancers and related surgical problems. The method was summarized from June 1987 to May 1997. 88 cases of esophageal and cardia cancer with sinus relief were confirmed by atropine test as 95.5% of vagal tone increase, compared with 785 cases of esophageal and cardiac cancer without sinus relief in the same period, and the lesion length and invasion depth were analyzed. The lymph node metastasis and surgical resection rate were compared. Results The sinus rhythm group was mostly patients with advanced tumors. The length of the lesions and the extent of invasion were significantly different from the control group (P<0.05), and the surgical resection rate was low (P<0.01). Moreover, the heart rate was significantly increased after surgical resection than the simple probe (P<0.01), and no operative death occurred. Conclusion Esophageal and cardiac cancer accompanied by sinus rhythm may be due to the vasculature or compression of the tumor to the vagus nerve. Most of these patients are in the advanced stage of the tumor and should be examined before surgery to avoid unnecessary exploration of the thorax.