高龄非小细胞肺癌患者的外科治疗

Surgical treatment of non-small cell lung cancer in elderly

目的探讨高龄非小细胞肺癌(NSCLC)患者行肺切除手术的意义及围术期的处理特点。方法对2008年5月-2010年2月开胸手术治疗的46例高龄(≥70岁)NSCLC患者进行回顾性分析,并与同期行开胸手术治疗的83例年龄≤60岁患者(对照组)进行比较。结果高龄组患者术前合并各种心血管系统和呼吸系统等疾病的比率显著高于对照组(P<0.05),肺功能指标均较对照组差(P<0.05)。高龄组患者行肺部分切除比例高于对照组,但两组患者行根治性肺切除手术率差异无统计学意义(P>0.05)。高龄组术后一般性并发症发生率(26.09%)显著高于对照组(10.84%),差异有统计学意义。全部患者无严重手术并发症发生,无围术期死亡。结论高龄非小细胞肺癌患者仍应积极和慎重地开展肺切除手术,选择合理的手术方式,加强围术期的管理,是高龄NSCLC患者手术获益的关键。

Objective To study the significance of pneumonectomy for non-small cell lung cancer（NSCLC） in elderly patients and the characteristics of its perioperative management.Methods Clinical data about 46 elderly NSCLC patients at the age of≥70 years who underwent pneumonectomy from May 2008 to February 2010 were retrospectively analyzed and compared with those about 83 control patients at the age of≤60 years who underwent pneumonectomy during the same period of time.Results The rate of NSCLC accompanying cardiovascular and respiratory diseases was significantly higher and the pulmonary function level was poorer in elderly patients than in healthy controls（P0.05）.The rate of pneumoresection was higher in elderly patients than in healthy controls（P0.05） with no difference in the rate of radical resection between the two groups.The overall rate of perioperative complications was obviously higher in elderly patients than in healthy controls（26.09% vs 10.84%,P0.05）.However,no severe operation-related complication and death occurred.Conclusion Pneumonectomy should be actively and carefully performed for NSCLC in elderly patients.Rational selection of the procedure and intensive perioperitive management are the keys to a satisfactory outcome.