老年肺癌全肺切除术的围手术期处理

Perioperative management of pneumonectomy in elderly patients with lung cancer

目的探讨全肺切除术对≥60岁老年肺癌患者的影响、手术适应证和围手术期管理。方法对47例≥60岁行全肺切除术肺癌患者进行回顾分析。结果术后并发心律失常28例,肺部炎症4例,呼吸衰竭3例,支气管胸膜瘘1例,经对症治疗后均好转。本组47例无围手术期死亡。结论≥60岁老年肺癌患者行全肺切除术有较大的风险,要根据肺功能状态和病变范围并结合血气分析、心脏功能等因素综合分析,合理选择适应证和术式,并重视围手术期管理。经充分准备,部分老年患者能进行全肺切除术。

Objective To explore the effect of pneumonectomy in elderly patients with lung cancer and indications of operation and perioperation management. Methods Forty-seven cases of pneumonectomy for lung cancer in patients aged 60 years and older were analyzed retrospectively. Results No patients died within 30 d after the operation. Postoperative complications occurred in 32 cases, including arrhythmia of 28 cases, respiration failure of 3 cases, and bronchopleural fistulas of 1 case. They were healed by heteropathy. Conclusions Pneumonectomy for lung cancer in patients aged 60 years and older has higher risks, so reasonable indications should be chosen according to pulmonary function and lesion range combined with blood gas analysis and heart function. Attention should be paid to perioperation management. With adequate treatment part of the old patients have the potential to undertake pneumonectomy.