食管癌根治术护理查房

概述手术要点重点组织学分类解剖护理问题临床表现诊断治疗主要手术步骤洗手护士配合要点巡回护士配合要点护理措施解剖前后扁窄的肌性管道上端：C6下缘续咽；下端：T11左侧与胃连接；生理狭窄食管入口处气管分叉处膈肌裂孔处颈段（5cm）食管入口---胸骨切迹胸段（18cm）胸骨切迹---膈裂孔处上胸段：胸骨切迹---主动脉弓上缘中胸段：主动脉上缘---肺下静脉下胸段：肺下静脉---膈裂孔腹段（2cm）膈裂孔--贲门食管分段上段食管入口--主动脉弓上缘中段主动脉弓上缘--肺下静脉下段肺下静脉--贲门临床分段发生于食管粘膜上皮的消化道恶性肿瘤男性多于女性我国食道癌发病率居世界之首，占各部位死亡率的第二位50~70岁最多见食管癌化学性病因：亚硝胺生物性病因：真菌微量元素缺乏：钼、铁、锌、氟、硒缺乏维生素：A、B2、C及动物蛋白、新鲜蔬菜、水果摄入不足遗传易感性食管癌前病变：食管慢性炎症、上皮不典型增生、贲门失弛缓症、疤痕狭窄等不良的嗜好及饮食习惯：酒、烟、茶，粗、热、硬、快及蹲食等习惯粘膜上皮损伤修复损伤细胞增生活跃癌变病理分型鳞状细胞癌腺癌腺角化癌小细胞未分化癌9.50%55.80%34.70%0%20%40%60%80%上段中段下段临床分型50-60%15-20%10%5-10%髓质型蕈伞型溃疡型缩窄型髓质型蕈伞型溃疡型缩窄型临床分型分期长度范围转移O不定限于粘膜层无早期Ⅰ〈3cm侵及粘膜下层无Ⅱ3-5cm侵及部分肌层无中期Ⅲ5cm侵及全肌层或外侵局部淋巴转移晚期Ⅳ5cm明显外侵远处淋巴结或血性转移临床病理分期TX：原发肿瘤不能测定T1：肿瘤侵及粘膜固有层或粘膜下层T2：肿瘤侵及肌层T3：肿瘤侵及食管纤维膜T4：肿瘤侵及邻近器官食管癌TNM分期Nx:区域内淋巴结不能测定N0：无远处转移N1：区域淋巴结转移Mx:远处转移不能测定M0：无远处转移M1：有远处转移颈部、锁骨上气管旁隆突下肺门肺下韧带主动脉旁食管旁贲门胃左血管旁临床表现早期：1.梗噎感2.胸骨后烧灼感3.异物感4.可无症状进展期：1.进行性吞咽困难（典型症状）2.呕吐3.胸背疼痛4.体重下降晚期：1.侵犯穿孔：疼痛、呛咳、呕血2.神经受累：声音嘶哑3.恶病质：消瘦、贫血、低蛋白4.远处转移：锁骨上淋巴结、肝脏诊断病史：进行性吞咽困难X线食管钡餐检查食管镜检查食管脱落细胞拉网检查CT检查超声内镜检查治疗手术治疗-根治性手术-姑息性手术内镜下治疗-食管扩张，食管支架-内镜下电灼切除、光动力疗法等化疗：5-Fu和顺铂为主放疗：外放射为主以手术为主的综合治疗早期食管癌中期（Ⅱ）颈段3cm胸上段4cm胸下段5cm全身情况好者中期（Ⅲ）病变在5cm以上无明显远处转移术前放化疗与手术综合放射复发，无远处转移，全身情况良好者病变侵犯范围大有远处转移全身情况差，呈恶病质手术疗法左进胸右进胸：管状胃三切口手术疗法ConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharewithfamily.Addflash-basedquizzesanddemostoslideshowtointeractwithyouraudience.LearnMoreLearnMoreLearnMoreConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharewithfamily.Addflash-basedquizzesanddemostoslideshowtointeractwithyouraudience.LearnMoreLearnMoreLearnMoreConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharewithfamily.Addflash-basedquizzesanddemostoslideshowtointeractwithyouraudience.LearnMoreLearnMoreLearnMoreConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharewithfamily.Addflash-basedquizzesanddemostoslideshowtointeractwithyouraudience.LearnMoreLearnMoreLearnMoreConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharewithfamily.Addflash-basedquizzesanddemostoslideshowtointeractwithyouraudience.LearnMoreLearnMoreLearnMoreConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharewithfamily.Addflash-basedquizzesanddemostoslideshowtointeractwithyouraudience.LearnMoreLearnMoreLearnMoreConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharewithfamily.Addflash-basedquizzesanddemostoslideshowtointeractwithyouraudience.LearnMoreLearnMoreLearnMoreConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharewithfamily.Addflash-basedquizzesanddemostoslideshowtointeractwithyouraudience.LearnMoreLearnMoreLearnMoreConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharewithfamily.Addflash-basedquizzesanddemostoslideshowtointeractwithyouraudience.LearnMoreLearnMoreLearnMoreConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharewithfamily.Addflash-basedquizzesanddemostoslideshowtointeractwithyouraudience.LearnMoreLearnMoreLearnMoreConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharewithfamily.Addflash-basedquizzesanddemostoslideshowtointeractwithyouraudience.LearnMoreLearnMoreLearnMoreConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharewithfamily.Addflash-basedquizzesanddemostoslideshowtointeractwithyouraudience.LearnMoreLearnMoreLearnMoreConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharewithfamily.Addflash-basedquizzesanddemostoslideshowtointeractwithyouraudience.LearnMoreLearnMoreLearnMoreConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharewithfamily.Addflash-basedquizzesanddemostoslideshowtointeractwithyouraudience.LearnMoreLearnMoreLearnMoreConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharewithfamily.Addflash-basedquizzesanddemostoslideshowtointeractwithyouraudience.LearnMoreLearnMoreLearnMoreConvertPowerPointtoflashforwebsharing.PostyourslideshowonMyspaceandblog.ConvertPowerPointtovideoorburntoDVD.PresentyourslideshowonTVtosharew