食道癌手术的麻醉管理课件.ppt

Anesthesia for esophageal cancer Part I Reporter R2 藍正妍 Supervisor VS 趙安怡 Carcinoma of the esophagus Epidemiology and etiology Pathology and pathogenesis Diagnostic evaluation Treatment Surgical approaches Perioperative mortality and complications Preoperative evaluation and preparation Monitoring Induction of anesthesia Choice of tracheal tube Intraoperative considerations and management Pain management Carcinoma of the Esophagus Most tumor are malignant Most prognostic factor: stage of disease Surgical therapy offers the best chance for cure with a complete resection Squamous cell carcinoma and adenocarcinoma SCC- Epidemiology and etiology Racial groups:African Americans Caucasians MF(3-4 times) Age 40 y/o Geographic and cultural variations Carcinogens: Tabacco, Alcohol, Nitrosamines, Furacin c, Opiates, Fungal toxins, Spices Nutritional deficiencies: Vit A, riboflavin, Trace elements, zinc Physical factors:thermal trauma, hot food or drinks, abrasive material (soil) and food, Lye Predisposing factors:Tylosis, Plummer-Vinson syndrome, Achalasia, Celiac sprue SCC- Pathology and pathogenesis 50% in middle third 30-40 % in lower third 10-20 % in upper third Macroscopic vs microscopic features Metastases:60% lymphatic Distant meta: lungs, liver, bone Adenocarcinoma- Epidemiology and etiology Age:68 y/o MF Caucasian African Americans Barrett’s metaplasia is the precursor lesion to esophageal adenocarcinoma(7-20%?ca) (GER?chronic inflammation?Barrett’s) Other risk factors: Obesity Ectopic gastric mucosa Esophageal diverticula Iron overload Alcohol use Polysaturated fats Diets high in red meat Diagnostic evaluation Initial evaluation and clinical staging History: dysphagia, pain, weight loss, hoarseness, dyspnea, cough Physical: organomegaly; supraclavicular or cervical LAP, SVC syndrome, Laboratory examination Radiology: barium swallow with UGI series, CT,Bone scan Endoscopy: esophagogastroscopy,bronchoscopy,endoscopic ultrasound, thoracoscopy and laparoscopy