老年人肺癌外科治疗596例临床分析

A clinical analysis of surgical treatment of 596 aged patients with lung carcinomas

目的对老年肺癌患者外科治疗的方法、结果和特殊性进行探讨。方法５９６例均在双腔支气管插管静脉复合麻醉下分别行不同术式的手术治疗，对手术方式、并发症、病理类型、术后生存率和老年患者特点等资料进行统计分析。结果手术切除率８７．６％，手术死亡率２．４％，术后并发症发生率１０．１％。随访率９０．３％。手术后３、５、１０年生存率分别为５０．８％、４０．１％、３４．４％。肺叶切除及袖式肺叶切除的生存率优于全肺切除（均为Ｐ＜０．０１），鳞癌、Ⅰ～Ⅱ期及无纵隔淋巴结转移者优于其它病理类型、Ⅲ～Ⅳ期及有纵隔淋巴结转移者（Ｐ＜０．０５或＜０．０１）。结论病理分期和纵隔淋巴结转移是影响生存的主要因素，Ⅲ期患者在以外科治疗为主的综合治疗下可以获得较高的５年生存率，应积极开展对老年人肺癌的外科治疗。

Objective\ To study the surgical measures,results and specificity for aged patients with lung carcinomas.\ \ Methods\ Five hundred and ninety six cases over 60 years of age were operated under transbronchio intravenous combined anesthesia by different ways.The ways of operation,complications,pathological types,postoperative survival rate and characteristics of aged patients were analysed.\ \ Results\ The resectability rate was 87 6%,postoperative mortality rate 2 4%,complication 10 1%.The survival rate of lobectomy and sleeve resection were higher than that of pneumonectomy( P <0 01).Those with squemous cell carcinoma,stage Ⅰ Ⅱ and without metastasis to mediastinal lymph nodes were better than those of other pathological types,stage Ⅲ Ⅳ and with metastas is to mediastinal lymph nodes.The follow up rate was 90 3%.The survival rate of 3,5,10 years was 50 8%,40 1%,34 4% respectively.\ \ Conclusions\ The pathological stage and metastasis of mediastinal lymph nodes are important factors affecting the prognosis.Stage Ⅲ patients under surgical and combined treatment may get higher 5 year survival rate.