| 摘要: |
| 目的 探讨老年非小细胞肺癌患者的外科治疗策略及疗效。方法 回顾性分析2010年1月至2012年12月于第二军医大学长海医院胸心外科诊治的113例老年非小细胞肺癌患者的临床资料,对其临床特征、治疗措施、手术入路及术式、术后结果进行统计分析。结果 全组64例患者选择手术治疗,其余患者转内科治疗；手术患者与非手术患者在日常体力状况评分及肺功能指标(FEV1%、VC%)上差异有统计学意义 (P值分别为0.001、0.046、0.038)。全组64例手术患者,胸腔镜手术占73.4%(47/64),其余26.6%(17/64)为常规开胸手术；肺叶切除手术56例,肺叶楔形切除术8例,全组无全肺切除；胸腔镜手术术中有2例患者中转开胸,中转开胸率4%(2/47)。术后并发症发生率18.8%(12/64),胸腔镜术后并发症发生率6.0%(3/47),常规开胸术后并发症发生率41.0%(7/17)；两种开胸方式术后肺部并发症发生率的差异有统计学意义 (P=0.006)。单因素及多因素logistic回归分析提示常规开胸方式是老年非小细胞肺癌患者术后肺部并发症发生的危险因素(P=0.01,P=0.03)。全组术后1例患者死亡。结论 日常体力状态以及术前肺功能指标是老年非小细胞肺癌患者是否选择手术的重要评估指标。胸腔镜手术可有效减少老年非小细胞肺癌患者术后肺部并发症的发生,降低围术期风险,当淋巴结钙化粘连导致局部解剖不清时,应考虑中转开胸。对于老年患者还应尽量避免全肺切除。 |
| 关键词: 肺肿瘤 非小细胞肺癌；外科治疗 老年人 危险因素 |
| DOI： |
| 投稿时间：2013-03-14修订日期：2013-06-19 |
| 基金项目: |
|
| Surgical procedure and prognosis analysis for elderly patients with non-small-cell lung carcinoma |
| ZHU Ji△,ZHAO Tie-jun△,CHEN He-zhong,YANG Li-xin,JIN Hai,LI Zhi-gang,XU Zhi-yun* |
(Department of Thoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| Objective To explore the surgical procedure and prognosis for elderly patients with early stage non-small-cell lung carcinoma (NSCLC). Methods The clinical data of 113 elderly patients with early stage NSCLC, who were treated in Changhai Hospital between January 2010 and December 2012, were retrospectively analyzed. The clinical features, treatments, surgical approaches, surgical procedures, and surgical outcomes were analyzed. Results Sixty-four patients received surgical treatment and others were transferred to internal treatment. There were significant differences in performance status (PS) and lung function (FEV1% and VC%) between the surgical patients and non-surgical patients (P=0.001, P=0.046, P=0.038). Of the 64 patients undergoing surgical treatment, 47 (73.4%) received video-assisted thoracic surgery (VATS) and 17 (26.6%) received open thoractomy. Fifty-six patients underwent lobectomy, 8 underwent limited resection, and none had pneumonectomy. Among VATS patients, two (4.0%) of the 47 patients were converted to thoractomy. The overall complication rate was 18.8% (12/64), the complication rate of the VATS group was significantly different from that of thoractomy group (6.0% vs 41.0%, P<0.05). Univariate and multivariate logistic regression analysis revealed that conventional open chest surgery was the independent risk factor for post-surgical complications in elderly NSCLC patients (P=0.01,P=0.03). Only one patient died after surgery. Conclusion Elderly NSCLC patients should not be denied for pulmonary resection if their performance status and lung function allow. VATS approach lobectomy can effectively reduce post-operation complications and decrease perioperative risks. Conversion to an open procedure should be considered in case of lymph node adhesions. Pneumonectomy should be avoided for elderly NSCLC patients. |
| Key words: lung neoplasms non-small-cell lung carcinoma surgical therapy aged risk factors |
