STUDY OF RESPIRATORY DISTRESS FOLLOWING ONE-STAGE RESECTION AND RECONSTRUCTION FOR ESOPHAGEAL CANCER UNDER THORACOTHOMY

We investigated the relationship between postopoerative respiratory distress and pulmonary infections in fifty patients who simultaneously underwent esophagectomy and esophageal reconstuction. Pulmonary oxygenation (respiratory Index (RI), A-aDO2), respiratory hemodynamics (Qs/Qt, Pulmonary microvascular pressure-Coloid osmotic pressure (Pmv-COP)) and biological responses (leukocyte, Complement (C3, C4) were analized. Results were as follows; 1) RI, A-aDO2 and Qs/Qt increased on the third postoperative day (POD) and gradually decreased in the patient group without pulmonary infections. In the group with pulmonary infectios, these figures increased remarkably and prolonged for improvement. These did't get improvement and get on exacerabation in the died group due to pulmonary infections. 2) In the died group due to pulmonary infections, Pmv-COP increased but remained at a negative value which kept from the 2nd POD. 3) In the died group, neutrophils were kept at lower levels, while increaded in the other groups. 4) In the group with pulmonary infections, C3 and C4 values were decreased on the 2nd POD which indicated a complement activation. These findings suggested that after one-stage operation for esophageal cancer the mechanical respiratory distress was kept until the 3rd or 4th POD, and if pulmonary infections occured, then the reactive pulmonary distress was superimposed on it.