高龄原发性肺癌的外科治疗

Surgical treatment of primary lung carcinoma in aged patients

目的:评价高龄原发肺癌外科治疗效果:方法:从1990年8月到1995年12月,我们为84例70岁以上高龄原发性肺癌患者进行手术治疗。男67例,女17例。其中鳞癌54例,腺癌21例,混合癌6例,其它3例。Ⅰ～Ⅱ期53例,Ⅲ～Ⅳ期31例:结果:手术切除73例,手术切除率86.9％,手术死亡率2.4％,并发症发生率10.7％:一年、二年、三年生存率分别为68.1％、42％、20.3％:结论:(1)对高龄原发性肺癌的手术治疗应采取积极态度,年龄不是手术禁忌,应考虑患者生理年龄及家族寿龄趋势。(2)不必过分强调手术根治性,即使姑息性手术也可减轻肿瘤负荷,为术后生物治疗提供更有效方法。(3)加强围手术期处理和选择适当手术方法是降低手术并发症和死亡率,提高生存率和生活质量的关键。(4)术后适当的辅助治疗(包括化疗、放疗和免疫治疗)可减轻症状,延长生命,提高生活质量。

Objective:To evaluate surgical treatment of primary lung carcinoma in aged patient. Methods: 84 patients with primary lung cancer who were surgically treated between August 1990 and December 1995. The ages of the 84 patients were all more than 70 years. There were 67 males and 17 females in this study. Histologic classification identified 54 squamous, 21 glandular, 6 combined and 3 other cell type carcinomas. Of the 84 cases, there were 53 in phase I~Ⅱand 31 in phaseⅢ~ Ⅳ . Results: 73 patients received surgical excision of tumors with the death incidence 2.4% , Operative rate is 86.9% . Complications 10.7% . The 1 - 2 - and 3 - year overall patient survivals were 68.1 %, 42%, and 30.3% respetively. Conclusion: The results suggest that: (1) Operation is the first choice in treatment of the aged patients with primary lung carcinoma. Physiological age and familial life span rather than the actual age of the patient should be considered. (2) It is not necessary to overemphasize rachical excisior of tumors, because optinal excision can decrease tumor loading to help effect biological therapy. ( 3) Perioperative management and suitable operative method are the key to decrease complication and mortality and increase survival rate and quality of life(QOL) (4) post -operative therapy could decrease symptoms and improve QOL of the patients.