Clinical Study On Postoperative Pulmonary Complications Of The Transthoracic And Transabdominal Resection On Prognosis Of Patients With Carcinoma Of Gastric Cardia

Background:carcinoma of gastric cardia is a common digestive tract tumor.It is a kind of glandular cancer which occurs in the epithelium of gastric cardia.Surgery is the first choice for the treatment of this cancer,But the Selections of surgical approach were Controversial.The transthoracic approach and Transabdominal approach were the frequently used approachs.Thus we made a retrospective analysis about the 2 approachs used on the 174 cases of the patients with carcinoma of gastric cardia.The clinical effect,Surgical complications were observedObjective:To observe and compare the clinical effect,Surgical complications and change of the immunologic function between the patients with carcinoma of gastric cardia who received the transthoracic approach and Transabdominal approach.Methods:The transthoracic approach and Transabdominal approach used in 174 cases with carcinoma of gastric cardia were analyzed retrospectively.98 cases(transthoracic approach group)recived surgical operation in transthoracic approach while the 76 cases(Transabdominal approach group)in Transabdominal approach.The Perioperative and Postoperative related index,including the operation time;intraoperative blood loss;length of patient stay;costs of treatment;postoperative fentanyl dose;the VAS;the incident of the Abnormal heart rate;abnormal blood pressure and the one year survival rate were analyzed.The Postoperative pulmonary(the pulmonary infection;pleural effussion;empyema;atelectasis;ARDS;respiratory failure)and other Related complications(the anastomotic leakage;anastomotic stricture;reflux Esophagitis;infection of incisional wound;abdominal infection and arhythmia)were compared.Results:(1)The operation time,Intraoperative blood loss,hospital stay,costs of treatment,Postoperative fentanyl dose and the VAS after the surgery of the transthoracic approach group were more than the Transabdominal approach group.(2)the incident of the Abnormal heart rate and Abnormal blood pressure,and the One year survival rate in transthoracic approach group were 13.27%,11.22%,74.49%,were significantly different from the Transabdominal approach group(2.63%,2.63%,86.84%).(3)the incident rate of the pulmonary infection,pleural effussion,empyema in Transabdominal approach group were lower than the transthoracic approach group(P<0.05).(4)the incident rate of the anastomotic leakage,Anastomotic stricture,Reflux Esophagitis,infection of incisional wound,abdominal infection and rate of arhythmia in the 2 groups had no significant difference(P>0.05).Conclusion:Transabdominal approach is preferred for the Patients with carcinoma of gastric cardia.But if there were some Unavoidable minus points,we can make the selection of the transthoracic approach under the condition of cardiopulmonary function...