J.Jpn. Surg. Soc.. 78(3): 223-232, 1977
Original article
STUDIES ON THE POSTOPERATIVE PULMONARY COMPLICATIONS OF THE ESOPHAGEAL CANCER. (STUDIES ON HEMODYNAMICS BY USING OF SWAN-GANZ CATHETER IN SURGICAL DISEASE 2ND REPORT)
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First Department of Surgery, Fukushima Medical College (Director : Prof. Kengi Honda) Masahiro Tsuboi |
On the clinical observation, pulmonary complications found in 51% of 147 cases and occupied 20% of the postoperative death. Among in pulmonary complications pleural complications were induced in 53 cases and pulmonary parenchymal complications were induced in 24 cases. Pleural complications were caused by the technical failure and pulmonary parenchymal complications by the postoperative care.
So, inorder to prevent the pulmonary complications, hemodynamics studies were carried out in 20 patients of esophageal cancers and 10 patients of control cases (disease of the stomach and colon). Mean pulmonary arterial pressure, pulmonary wedge pressure, right atrium pressure and cardiac output were measured by using of Swan-Ganz flow directed catheter on pre- and postoperative courses.
The preoperative values of the control cases showed normal values. Those of the esophageal cancer were lower than these of the control cases, but showed normal values.
The postoperative changes of these values of the control cases were within the normal ranges. However, those of the esophageal cancer passed 24-36 hrs after operation in the lower level, but at 72 hrs after operation, especially, PAP rised over the normal range. On 4-5 days after operation, those values decreased to the level of these values in the normal.
In cases with pulmonary parenchymal complications, the PAP increased over 20 mmHg, but by application of diuretica or decreasty of the volume of infussion the PAP decreaed under 20 mmHg and the pulmonary parenchymal complications disappeared.
From these results, the control of the PAP-level should be kept under 20 mmHg for prevention of the postoperative pulmonary parenchymal complications.
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