老年肺癌外科治疗临床研究

The effect of surgery on elderly patients with lung cancer

目的:对老年人肺癌外科治疗进行分析,探讨外科治疗老年肺癌的特殊性及防治措施。方法:回顾性分析我院胸外科1974-2009年收治60-82岁肺癌患者517例的临床资料。本组肺切除498例,其中全肺切除61例、肺叶切除428例、局限性肺切除9例、探查19例。结合老年人肺癌的临床特点,重点就术式的选择及围手术期的防治措施进行探讨。结果:本组肺癌切除率为95.1%,手术死亡率1.2%。术后1年、3年、5年生存分别为398例、167例、108例,有18例患者已生存10年以上仍健在。单纯剖胸探查19例,1年生存5例,其余均于术后2年内死亡。结论:非小细胞肺癌以手术为主的综合治疗临床效果较好。单纯年龄因素并非手术绝对禁忌证,严格掌握手术指征,加强围手术期的管理,注重防治术后低氧血症等措施,是可以取得成功的,根治性肺叶切除术是高龄患者的首选方式。

Objective：To explore the particularity and management of the surgical treatment in the lung cancer of elderly patients.Methods： The clinical data of 517 cases with lung cancer aged 60-82 treated in our hospital from 1974-2009 were retrospectively analyzed.Pneumonectomy was performed in 498 cases,among them,total pneumonectomy was performed in 61 cases,lobectomy in 428 cases,partial lobectomy in 9 cases,and exploratory thoractomy in 19 cases.Combined with the clinical characteristic of lung cancer in the elderly patients,the emphasis on the selection of surgical modality and prevention and treatment of perioperationg was explored.Results： The resective rate of lung cancer was 95.1%,the operative motality was 1.2%.There were 398 cases,167 cases and 108 cases survived 1,3and 5 years respectively,and 18 cases survived 10 years after operation.In 19 cases with only exploratoty thoractomy,5 cases survived 1 year,but all died within 2 years.Conclusion： The clinical effect of comprehensive therapy mainly containing operation for non-small cell lung cancer was satisfactory.The age was not the absolute restriction for surgery,the operation could be successful,if the operative indication was grasped strictly,the perioperative care was strengthened and postoperative hypoxemia was prevented and treated attentively.The radical lobectory was the first choice for elderly patients.