高龄患者电视胸腔镜手术与传统开胸手术后心肺并发症的分析

Analysis of postoperative cardiovascular and lung complications in the elder patients undergoing the VATS and the traditional thoracotomy

目的比较70岁以上高龄患者行电视胸腔镜手术(VATS)和传统开胸手术后心、肺并发症的发生情况。方法将388例行胸外科手术的高龄患者根据手术方式不同分为VATS组和传统开胸组。VATS组70例,平均年龄(75.2±2.5)岁;传统开胸组318例,平均年龄(73.1±2.9)岁(P<0.05)。结果VATS组手术后心肺并发症总发生率18.6%,传统开胸组31.5%(P<0.05)。在术后有心肺并发症的患者中,VATS组心脏并发症发生率38.5%,传统开胸组49.0%(P>0.05);VATS组术后肺并发症发生率61.5%,传统开胸组68.0%(P>0.05)。术后两组心脏并发症总发生率47.8%,肺并发症总发生率67.3%(P<0.01)。结论因胸部疾患行胸外科手术的高龄患者,VATS组术后心肺并发症的总发生率明显低于传统开胸组。全组术后肺部并发症发生率明显高于心脏并发症。因此,为了手术安全,对高龄患者应提倡采用创伤小的VATS,以减少术后心肺并发症的发生。

Objective To compare and analyse the postoperative cardiovascular complications and the lung complications in the elder patients over 70 years old who underwent the video assisted thoracic surgery（VATS） and the traditional thoracotomy. Methods 388 elder patients were divided into two groups： 70 patients in the VATS group, the mean age was 75. 2 ± 2. 5, the others in the traditional thoracotomy group, the mean age was 73.1 ±2.9 （P〈0.05）. Results 18.6% and 31.5% of the patients in VATS group and the traditional thoracotomy group, respectively suffered from postoperative cardiovascular and/or lung complications （ P 〈 0. 05 ）. The morbidity rates of the postoperative cardiovascular complications were 38.5% and 49. 0% in VATS group and the traditional thoracotomy group, respectively （ P 〉 0. 05 ）. The morbidity rates of the postoperative lung complications were 61.5% and 68.0% in VATS group and the traditional thoraeotomy group, respectively （P 〉 0. 05 ）. The morbidity rates of the total postoperative cardiovascular complications and lung complications were 47. 8% and 67. 3%, respectively（P 〈0. 01 ）. Conclusion The morbidity of the postoperative complications in the elder patients who underwent VATS was obviously lower than that in the patients who underwent the traditional thoracotomy. So VATS is safer operations for the elder patients