Thoracic esophageal cancer surgery is more invasive surgery, because to be involved thoracic and abdominal cavities of two surgical procedures, so the impact of respiratory and circulatory system are more serious than other chest surgery. Therefore, preoperative esophageal cancer patients should be more careful and meticulous preparation.
Esophageal cancer surgery 1. Detailed history and comprehensive physical examination
Learn more about history and through detailed and thorough physical examination, the patient's health status and function of various vital organs to judge, for example, sick patients can engage in manual labor or insist on prior work, there is no labor, chronic cough and palpitations breath history. Determined to those suspected of pulmonary insufficiency, heart and lung function tests do.
(1) squat test. Check the count before resting state blood pressure, pulse and respiratory rate, and then start the patient stand straight, squat movement 10 times, the rapid measurement of blood pressure, pulse and respiration, 2min after the first test in mind. After the test, such as pulse per minute increased by not more than 20 times, no more than 6 times increase in breathing, blood pressure increased by not more than 1.33kPa, 2min within the pulse, respiration and blood pressure were restored the number of persons before the test is normal.
(2) breath test. After the patient deep inspiration breath test recorded the time, and then let the patient breath after deep breath test recorded the time, breath longer than is normal for more than 30s, 20s tips below to reduce the cardiac function, 15s The following are significant respiratory dysfunction. Based on the above test, if the patient determination, reduce lung function, heart function should do checks and pulmonary function tests.
Esophageal cancer surgery 2. Control of arrhythmia
Arrhythmia seen in patients with esophageal cancer is not only organic heart disease, hyperthyroidism, electrolyte imbalance, and a variety of infections and autonomic nerve dysfunction is a common cause of arrhythmia induced, it is necessary to identify its causes in order to give appropriate treatment. For patients undergoing elective surgery should be controlled in the arrhythmia after surgery. Arrhythmia does not affect hemodynamics and cardiac function were generally tolerate surgery; arrhythmia caused by ischemic heart disease from the surgery should be careful; ST-T changes in E III degree room with a room block, or accompanied by multi-source form of premature ventricular beats or more was more than triple law, operative mortality rate was significantly increased; III degree AV block risk arrest at any time must be placed only after pacemaker surgery risk of left bundle branch block of great attention should be paid.
3. Preoperative treatment of patients with diabetes
Preoperative blood glucose levels must understand the various state organs, especially kidney disease, to understand the past, intoxicated patients without acidosis, low blood tie, ECG abnormalities, response to various drugs, and history of low blood sugar episodes. Adequate control of blood glucose before surgery, the best two weeks of treatment before surgery, blood sugar control in 7.2_8.3mmol / L, urine glucose, urine intoxicated (a), no symptoms of acidosis intoxicated before surgery. Oral hypoglycemic agents, needs to be changed 3 days before surgery, insulin regular film, the original film with a long-acting insulin before surgery should also be changed to those of ordinary membrane insulin.
4. Blood, urine routine examination and biochemical
If abnormal test results should be reviewed in the near future.
5. Strengthen nutrition
Preoperative period, patients should be given to high-protein, high-calorie diet. Removal of the obstruction likely serious cases, several days before surgery can be based on daily intake of less than, doing intravenous fluid and electrolyte supplement.
6. No smoking
Smoking habits after admission of patients stop smoking.
7. Interpretation
Preoperative physician should any of the extreme negative ben, extreme enthusiasm to explain the attitude of the patient to do the work, to encourage patients to establish the confidence to overcome the disease, the lifting of ideological concerns, indicating that patients should be in line with the treatment of attention, in order to achieve the patient closely with the smooth completion of surgery.
8. The application of antibiotics
General preoperative prophylactic antibiotics, but patients with respiratory infections, patients given daily 3 days before penicillin and streptomycin family of antibiotics family, while giving cough and sputum drug treatment method.
Esophageal cancer surgery 9. Wash esophageal
Preoperative patients with esophageal flushing to bring some pain. Obstruction light on the esophagus of patients can not do washing. Severe obstruction of the patients before surgery on the 2nd rinse with warm salt water every night after dinner one esophagus, 1.0g streptomycin solution given day taking place on the morning of surgery when the stomach tube and then a warm salt water rinse esophagus. Surgery liquid diet the day before eating dinner, before going to bed to give phenobarbital (luminal) 0.19 oral or intramuscular injection. Fasting on the morning of surgery, placed nasogastric tube. Esophageal replacement with colon for the proposed line should be fully aware of the situation colon. 3 days before surgery for bowel preparation, into a small residue liquid diet, oral neomycin, metronidazole lag, an enema every night, on the morning of surgery cleansing enema with warm salt water.