非小细胞肺癌患者合并慢性阻塞性肺疾病的临床特征分析

Clinical characteristics of chronic obstructive pulmonary disease in patients with non-small-cell lung cancer

目的探讨胸外科住院非小细胞肺癌患者合并慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）的临床特点及围术期治疗情况，为临床诊治提供合理建议。方法收集总结2013年1月至2016年12月兰州大学第二医院胸外科新诊断收治的非小细胞肺癌住院患者临床资料，回顾性分析非小细胞肺癌合并COPD的发生率、临床特征、术后肺部并发症、COPD诊断及围术期肺康复治疗情况。结果期间共收治非小细胞肺癌患者726例，将675例进行全套肺功能测定患者纳入研究，其中95例接受支气管舒张试验，86例符合COPD诊断而纳入合并COPD组，未合并COPD组589例。合并COPD组中男性（69例，80.2%，χ^2＝24.032）、年龄≥65岁（51例，59.3%，χ^2＝6.784）、有吸烟史（55例，64.0%，χ^2＝29.474）和大量吸烟者（43例，50.0%，χ^2＝5.802）、肺鳞癌（47例，54.7%，χ^2＝6.241）的比例高于未合并COPD组，差异有统计学意义（P〈0.05）；合并COPD组肺癌根治术后肺部并发症发生率为23.9%（16/67），明显高于未合并COPD组13.7%（78/568）（χ^2＝4.894，P〈0.05）；肺康复治疗组术后肺部并发症发生率为13.5%（5/37）低于未行肺康复治疗组患者36.7%（11/30）（χ^2＝4.886，P〈0.05）；86例（12.7%）合并COPD患者入院时临床诊断COPD仅6例（8.9‰），出院时仅23例（3.4%），出院医嘱中均未给出COPD规范治疗的建议。结论非小细胞肺癌常合并COPD，尤其是老年、男性、有吸烟史及肺鳞癌患者，但临床对合并症COPD诊断和治疗严重不足，胸外科医生应在诊治肺癌过程中早发现和规范治疗COPD，以改善预后。

Objective To explore the clinical characteristics and perioperative treatment of chronic obstructive pulmonary disease （COPD） in patients with non-small-cell lung cancer （NSCLC） in department of thoracic surgery, and to guide the clinical diagnosis and treatment.Methods From January 2013 to December 2016, patients with newly diagnosed NSCLC treated in the thoracic surgical department of Lanzhou University Second Hospital were reviewed retrospectively.The patients were divided into the COPD group and non-COPD group.The clinical data, including the incidence and clinical characteristics of COPD in non-small-cell lung cancer, pulmonary complications after surgery, COPD diagnosis and perioperative pulmonary rehabilitation were analyzed retrospectively.Results A total of 726 NSCLC patients were reviewed, six hundred and seventy-five cases who took the full lung function test were included in the study, of which 95 cases received bronchial diastolic test, 86 cases were accorded with COPD diagnosis and were included in incorporated COPD group, and 589 cases were in the non- incorporated COPD group.The proportion of men （69 cases, 80.2%, χ^2=24.032）, age ≥65 （51 cases, 59.3%, χ^2=6.784）, smoking history （55cases, 64.0%, χ^2=29.474） and a large number of smokers （43 cases, 50.0%, χ^2=5.802） and lung squamous cell carcinoma（47 cases, 54.7%, χ^2=6.241） in the incorporated COPD group were higher than those in differences were statistically significant （P〈0.05）; the incidence of pulmonary complications after radical resection of lung cancer in the incorporated COPD group was 23.9% （16/67）, which was significantly higher than that in the unincorporated COPD group（13.7% （78/568）） （χ^2=4.894, P〈0.05）. The incidence of pulmonary complications in the lung rehabilitation group was 13.5% （5/37）, lower than that of the non-lung rehabilitation group （36.7% （11/30）） （χ^2=4.886, P〈0.05）; Among the 86 cases （12.7%） of incorporated COPD, only 6 cases （8.9 ‰） were diagnosed with COPD at the time of admission, and 23 cases （3.4%） at discharge.No COPD guidelines were given.Conclusion NSCLC often combined wtith COPD, especially in males, elders （≥65 years old）, smokers, squamous cell carcinoma patients.At present, the diagnosis and treatment of co-morbidity of COPD is seriously inadequate, which needs to be paid much attention to by the thoracic surgeons, in order to improve the diagnosis and treatment of COPD, and improve the prognosis of the patients with NSCLC and COPD.