70岁以上老年人肺癌273例的外科治疗

Surgical treatment for lung cancer in 273 patients aged 70 and over

目的 分析 70岁以上老年人肺癌手术适应证、肺功能保护、围手术期处理以及影响预后的因素。 方法 全组 2 73例 ,年龄 70～ 85岁 ,平均 77 5岁。Ⅰ期 85例 ,Ⅱ期 137例 ,Ⅲ期 5 1例。肺段和楔形切除 17例 ,单纯肺叶切除 (包括双叶切除 ) 15 8例 ,支气管袖式肺叶切除 2 1例 ,肺动脉加支气管袖式肺叶切除 6例 ,全肺切除 6 5例 ,右肺上叶切除加隆突切除重建 4例 ,右肺上、中叶加隆突切除重建 2例。 结果 并发症发生率 4 3 6 % ,病死率 4 3% ,围术期死亡 9例 (3 3% ) ,其中循环衰竭 5例 ,呼吸衰竭 4例 ,总 5年生存率 4 4 2 % ,Ⅰ期、Ⅱ期、Ⅲ期患者 5年生存率分别为73 2 %、32 6 %、15 0 % ,预后危险因素为 :长期大量吸烟 (P =0 0 0 4 )、肺癌Ⅲ期 (P =0 0 13)及慢性阻塞性肺部疾病 (P =0 0 4 2 )。 结论 70岁以上老年人肺癌肿瘤的侵袭与转移发生较慢 ,在严格选择手术适应证的前提下 ,结合术中肺功能保护及周密的围术期处理 ,患者术后可获得相对良好的远期预后 ,应采取积极的手术治疗。

Objective To study the operative indication, surgical techniques,perioperative management and prognostic factor for lung cancer in the elderly patients Methods Two hundreds and seventy three elderly patients with lung cancer,aged from 70 to 85 years with mean age of 77 5 years, were analysed. Of 273 cases, 85 patients were in the stageⅠof cancer, 137 in stageⅡ, 51 in stage Ⅲ Surgical procedures included segmentectomies and wedge resection for 17 patients, lobectomies for 158 patients, sleeve lobectomy for 27 patients, pneumonectomies for 65 patients, lobectomies plus carinal reconstruction for 6 patients including 2 concomitant replacement of superior vena cava with vascular prosthesis Long term follow up was performed Results Perioperative death happened in 9 (3 3%), including circulatory failure in 5(1 8%) and respirtory failure in 4(1 5%) The 5 year survival rates for stageⅠ, stageⅡand stage Ⅲ patients were 73 2%, 32 6%, 15 0%, respectively Pathologic stage Ⅲ, chronic obstructive pulmonary disease and smoking were risk factors for long term survival Conclusions Elderly patients with lung cancer should undergo surgical therapy Operative indications, active protection of pulmonary function and careful perioperative management are necessary for obtaining good therapeutic results and long term prognosis in elderly patients