高龄肺癌患者术中和术后严重并发症分析

The perioperative complications for elderly patients with lung cancer associated with a pulmonary resection

目的探讨高龄肺癌患者手术中和术后并发症的发生及其对患者的影响。方法对2000年至2011年住院手术的182名年龄超过70岁的(老年组)肺癌患者和196名(对照组)年龄为30～60岁的患者术中和术后所有并发症进行回顾性分析。结果老年组肺段切除率高于对照组,肺叶切除率相对较低,手术后心脏意外及肺部并发症的发生率老年组高于对照组。手术中,异丙酚的用量老年组低于对照组,手术时间少于对照组,但老年组拨管时间明显延长,术后胸腔并发症发生率明显升高,术后气胸发生率较高,两组患者术后死亡率及住院天数没有明显差别。结论老年肺癌患者术后并发症明显升高,但术后死亡率及住院时间没有明显变化,对老年患者施行创伤较小的肺段切除,是一种安全、合理的手术方式。

Objective To evaluate the perioperative complications associated with surgery in pa- tients over 70 years of age with lung cancer. Methods A single-center retrospective evaluation was conduc- ted of perioperative complications （2000-2011） in lung cancer surgical patients. We reviewed and analyzed the clinical records of 182 consecutive patients over 70 years of age and 196 control patients. Results A segmental or wedge resection was performed more frequently for the elderly group than in the control group, whereas pneumonectomies and lobectomies were performed more frequently in the control group. Postopera- tive comorbidities such as cardiac and thoracic diseases were more frequently recognized in the elderly group than in the control group. The quantity of propofol used as induction anesthesia in the elderly group was sig- nificantly smaller than that of the control group, furthermore, the operation time of the elderly group were significantly shorter than that of the control group, however, extubation time was significantly prolonged. The ratio of thoracic complications in the elderly group was higher than that in the cdntrol group. The ratio of pulmonary leakage in the elderly group was higher than that in the control group ; however, there was no sig- nificant difference in length of stay in the hospital, the ratio of operative death and hospital death between the two groups. Conclusions Elderly patients more frequently have perioperative complications than youn- ger patients; however, there was no statistical difference in mortality. A segmental resection of lung for eld- erly patients may therefore be as feasible as in younger patients.