肺叶切除术肺叶切除术、肺楔形切除术与肺段切除术治疗老年肺楔形切除术与肺段切除术治疗老年Ⅰ期非小细胞肺癌患者的疗效及对预后的影响

Efficacy of pulmonary lobectomy,pulmonary wedge resection and pulmonary segmentectomy in treatment of elderly patients with stage I non-small cell lung cancer and the effect on prognosis

目的目的对比肺叶切除术、肺楔形切除术与肺段切除术治疗老年Ⅰ期非小细胞肺癌(NSCLC)患者的疗效及对预后的影响。方法方法将105例老年Ⅰ期NSCLC患者按手术方式的不同分为A组(肺叶切除术,n=36)、B组(肺楔形切除术,n=32)、C组(肺段切除术,n=37)。比较3组患者围手术期指标、围手术期并发症发生情况、肺功能指标[用力肺活量(FVC)、肺一氧化碳弥散量(DLCO)、最大通气量(MVV)]、术后随访情况(复发、远处转移和死亡)。结果结果B组患者手术时间、术后引流时间、术后住院时间均短于A组、C组,C组患者手术时间短于A组,差异均有统计学意义(P﹤0.05)。3组患者围手术期并发症总发生率比较,差异无统计学意义(P﹥0.05)。术后6个月,A组患者FVC、DLCO均较术前降低,B组、C组患者FVC、DLCO、MVV均高于A组,差异均有统计学意义(P﹤0.05)。术后随访1年,3组患者复发、远处转移情况比较,差异均无统计学意义(P﹥0.05),3组患者均未出现死亡。结论结论亚肺叶切除术可促进老年Ⅰ期NSCLC患者术后恢复和肺功能改善,建议临床根据患者实际情况选择术式。

Objective To compare the efficacy of pulmonary lobectomy,pulmonary wedge resection and pulmonary segmentectomy in the treatment of elderly patients with stage I non-small cell lung cancer(NSCLC)and the effect on prognosis.Method A total of 105 elderly patients with stage I NSCLC were divided into group A(pulmonary lobecto-my,n=36),group B(pulmonary wedge resection,n=32)and group C(pulmonary segmentectomy,n=37)according to dif-ferent surgical methods.Perioperative indexes,perioperative complications,pulmonary function indexes[forced vital ca-pacity(FVC),diffusion capacity of carbon monoxide of lung(DLCO),maximal voluntary ventilation(MVV)],postopera-tive follow-up(recurrence,distant metastasis,and death)of the 3 groups were compared.Result The operative time,postoperative drainage time and postoperative hospitalization time of group B were shorter than those of group A and group C,and the operative time of group C was shorter than those of group A,the differences were statistically significant(P<0.05).There was no significant difference in the total incidence of perioperative complications among 3 groups(P>0.05).Six months after operation,FVC and DLCO in group A were lower than those before operation,FVC,DLCO and MVV in group B and group C were higher than those in group A,the differences were statistically significant(P<0.05).After 1 year follow-up,there were no statistical significances in recurrence and distant metastasis among the 3 groups(P>0.05),and no death occurred in the 3 groups.Conclusion Sublobectomy can promote postoperative recovery and pulmo-nary function improvement in elderly patients with stage I NSCLC.It is recommended to choose the operation according to the actual situation of patients.