高龄老人肺癌切肺手术治疗的探讨

EXPLORE THE OPERATION OF LUNG CANCER IN OLDEST OLD

目的 结合国内外文献，探讨高龄肺癌患者手术治疗的价值。方法 分析１９８５～１９９５年上海市胸科医院４例８０岁以上高龄肺癌切肺手术的结果。结果 ４例均为男性，平均年龄８２．３岁（８０～８６岁），均为Ｉ期肺癌；右上叶切除２例、右下叶和左下叶切除各１例。３例术前给予积极的术前准备，术后都康复出院；１例术前未作特殊准备，术后９天死于脑栓塞。结论 对高龄肺癌患者的切肺手术应抱积极的态度，单纯年龄因素并不是手术的绝对禁忌症，应全面考虑患者的综合情况，包括实际年龄与生理年龄的差距、有无伴有重要脏器的疾病、心肺功能、肺癌的分期、手术切除的可能性、术后预期生存时间和重视围术期的处理等。

Objective: To determine the surgical value for oldest old with bronchogenic carcinoma. Methods From 1985 to 1995 four patients with lung cancer aged 80 or over were given resection at Shanghai Chest Hospital. Results All cases were at stage I and were taken lobectomy, 2 right upper cases, 1 right lower and 1 left lower. One case who had not received preoperative preparation actively died of cerebral embolism 9 days postoperatively, the other 3 patients were discharged recovered completely. Conclusions It is considered that for oldest old patients with lung cancer, surgical treatment is the favourable treatment to be selected. The age of elderly is not the absolute contraindication of thoracotomy. If the elderly patient has normal physiological condition, without other severe systemic diseases especially the pulmonary and cardiovascular diseases and the possibility of resection, an active surgical procedure will be considered. Meantime a great attention must be paid to the perioperative preparation, postoperative care and management.