肺癌住院手术患者临床特征与就诊模式的关系

Relationship between Clinical Characteristics and Diagnostic Modes of Hospitalized Surgical Patients with Lung Cancer

背景与目的肺癌患者的就诊模式(就诊原因)可能决定其治疗方案,而二者之间的关系仍不清楚,研究肺癌住院手术患者的临床特征与就诊模式的关系,有助于临床和卫生管理决策。方法分析2013年1月-2013年12月间华西医院胸外科手术治疗的505例肺癌患者临床特征,按照就诊模式分组如下:体检组为无症状或无明显症状下体检发现肺癌入院手术治疗患者(131例),症状组则为因出现症状而入院诊疗的患者(374例),分析两组的手术方式、病理分期等方面的差异;同时分析城市、乡镇患者就诊模式方面的不同。结果 131例体检组患者中,体检的方式以低剂量计算机断层扫描(low-dose computed tomography,LDCT,46.6%,61/131)和胸片(51.1%,67/131)为主,体检发现肺癌入院手术治疗的城市患者(35.4%,81/229)高于乡镇(18.1%,50/276)(P<0.001);体检发现I期肺癌患者在城市(46.8%,59/126)高于乡镇(27.3%,33/121)(P=0.001)。VATS肺叶切除术在体检组(73.3%,96/131)高于症状组(44.4%,166/374)(P<0.001)。病理分期为I期的肺癌患者在体检组(70.2%,92/131)显著高于症状组(41.4%,155/374)(P<0.001)。结论城市健康体检人群显著高于乡镇,健康体检有助于发现早期肺癌患者和行微创外科治疗。

Background and objective Diagnostic modes may play an important role in treatments, but minimal information is available regarding their relationship in patients with lung cancer. This study may contribute to decision making in clinics and public health centers. Methods The records of 505 hospitalized surgical patients with lung cancer at the Department of Thoracic Surgery, West China Hospital of Sichuan University from January 2013 to December 2013 were retrospectively reviewed. The patients were categorized into physical examination group （PEG, 131 patients） and symptomatic group （SG, 374 patients）. Surgical approach, pathological stage, and diagnostic mode were analyzed. Results Low-dose computed tomography （46.6%, 61/131） and computed radiography （51.1%, 67/131） were used as key diagnosis methods in 131 patients in PEG. The percentage of hospitalized surgical patients with lung cancer detected via physical examination in the city （35.4%, 80/229） was also significantly higher than in the township （18.1%, 50/276） （P〈0.001）. The ratio of stage I lung cancer detected via physical examination in the city （46.8%, 59/126） was significantly higher than that in the township （27.3%, 33/121） （P=0.001）. The proportion of patients who underwent VATS lobectomy was significantly higher in PEG （73.3%, 96/131） than that in SG （44.4%, 166/374） （P〈0.001）, and the ratio of patients at stage I was significantly higher in PEG （70.2%, 92/131） than that in SG （41.4%, 155/374） （P〈0.001）. Conclusion The use of physical examination is more prevalent in cities than that in towns, and its combination with mini-invasive surgical treatment contributes to early diagnosis of patients with lung cancer.