抄録
From 1980 to 1984, resections of esophageal cancer were performed upon 167 out of 281 patients in our department.
The volume of blood loss and blood transfusion in those patients were analyzed. The average blood loss in operation was 1021±554ml, and each case required about 5 units blood transfusion. 10 units packed cells and 10 units fresh frozen plasma were prepared in cases of radical operation for esophageal cancer. This volume was sufficient for the maximum surgical blood order schedule (MSBOS) for esophageal cancer surgery.
In order to study the usage of colloid in all resectable cases in 1981 and 1982, various hemodynamic indicators were investigated using a Swan-Ganz flow directed catheter. Plasma colloid osmotic pressure (PCOP) was measured by membranosmometer, and alveolar-arterial oxygen difference (A-aDO2) calculated by the blood gas analysis was measured. The results were obtained as follows: in the early postoperative period, values of PCOP-PA (mean pulmonary pressure) decreased remarkably, and A-aDO2 increased, compared with the preoperative values of those factors. Those results indicate that pulmonary water retension may be estimated by calculating those factors and the patients who underwent radical surgery for esophageal cancer may be easily susceptible to pulmonary complications, especially, pulmonary edema.
Transfusion of fresh frozen proteins (FFP) is effective in maintaining normal plasma protein level and plasma albumin level during the catabolic phase after operation, but the usage of albumin as nutritional support is not recommended from the metabolic point of view.
Hyperalimentation by active and appropriate combination of enteral and parenteral nutrition is one of the most practical and important therapies for patients with hypoproteinemia throughout the course of treatment for cancer of the esophagus.
