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目的：探讨食管、贲门癌切除术后严重并发症的预防和处理。方法：１９８３年４月至１９９５年６月间连续手术切除治疗食管癌，贲门癌１２３８例。其中食管癌５６３例，贲门癌６７５例。食管癌经左胸切除弓上吻合９３例，弓下吻合４５例；经上腹、右胸后外侧二切口切除３３８例；经右胸后外侧、上腹和左颈三切口切除８１例；食管内翻拔脱术５例，单一右胸切除１例。贲门癌经左胸切除３３３例，经腹切除２９９例，经胸腹斜切口切除４３例。结果：术后有１１４例发生并发症，４１例为肺部并发症，占３６％，发生率最高，术后无吻合口瘘发生，无术后３０日死亡及住院死亡。结论：笔者认为：降低手术死亡率的重点是预防吻合口瘘，根据不同的病变部位选择恰当的手术径路，以便获得充分的手术暴露，吻合方法和技术是关键，食管粘膜延长法食管胃定点一层吻合术能可靠地预防瘘的发生。此外要及时有效地处理术后并发症，发生呼吸衰竭要尽早作气管切开。
Objective: To investigate the prevention and management of severe complications after resection of esophageal and cardiac cancers. Methods: From April 1983 to June 1995, surgical resection was performed to treat 1238 cases of esophageal and cardiac cancers. There were 563 cases of esophageal cancer and 675 cases of cardiac cancer. In esophageal cancer, 93 cases underwent left thoracic resection and arch anastomosis; 45 cases underwent anastomosis; 338 cases underwent two incisions on the upper abdomen and right thorax; and 81 cases underwent three incisions on right posterolateral, upper abdomen and left neck; Invagination and dissection in 5 cases, a single right thoracic resection in 1 case. There were 333 cases of cardiac cancer undergoing left thoracic resection, 299 cases underwent abdominal resection, and 43 cases underwent transthoracic oblique incision. Results: There were 114 postoperative complications and 41 cases were pulmonary complications, accounting for 36%. The incidence was highest. There was no anastomotic fistula after operation, no postoperative 30-day death and hospital death. Conclusion: The author believes that: The focus of reducing operative mortality is to prevent anastomotic leakage, according to different lesions to select the appropriate surgical approach in order to obtain adequate surgical exposure, anastomosis methods and techniques are the key, esophageal mucosa extension method esophageal stomach fixed one Layered anastomosis can reliably prevent the occurrence of hemorrhoids. In addition, timely and effective treatment of postoperative complications, respiratory failure occurred as soon as possible for tracheotomy.