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目的探讨70岁以上老年人非小细胞肺癌手术治疗的结果及围手术期并发症对预后的影响。方法回顾性分析宣武医院胸外科自2005年1月至2008年10月,手术治疗的70岁以上老年非小细胞肺癌患者116例,年龄70~82岁,平均74.4岁。随访满5年,生存数据统计到2013年4月,随访率91.4%。结果术后临床病理TNM分期Ⅰ期17例(14.7%):ⅠA期5例,ⅠB期12例。Ⅱ期为42例(36.2%):ⅡA期11例,ⅡB期31例。Ⅲ期57例(49.1%):ⅢA期50例,ⅢB期7例。全肺切除9例(7.8%),肺叶切除97例(83.6%),楔形切除或肺段切除10例(8.4%)。5年生存率Ⅰ期65.3%,Ⅱ期42.6%,Ⅲ期18.7%(P<0.05)。Ⅰ、Ⅱ、Ⅲ期术后患者的无病生存时间分别为(61.7±3.5)个月、(44.8±3.7)个月、(28.9±2.6)个月(F=8.741,P=0.005),总生存期分别为(66.3±2.7)个月、(54.6±1.8)个月、(32.7±2.4)个月(F=4.941,P=0.036)。患者共出现围手术期并发症47例(40.5%),围手术期死亡率为1.7%。术前是否合并心肺血管疾病所导致的患者术后生存期的差异无明显统计学意义。结论对于70岁以上的老年肺癌患者,术前合并心肺血管疾病一般不是手术禁忌。重视术前心肺脑功能评估,选择适当的手术方式,可获得良好的远期生存。
Objective To investigate the results of surgical treatment of non-small cell lung cancer in the elderly over 70 years old and the influence of perioperative complications on the prognosis. Methods A retrospective analysis of Xuanwu Hospital thoracic surgery from January 2005 to October 2008, surgical treatment of elderly patients over the age of 70 non-small cell lung cancer 116 patients, aged 70 to 82 years, mean 74.4 years. Follow-up of 5 years, survival data statistics to April 2013, follow-up rate of 91.4%. Results Postoperative pathological TNM staging stage Ⅰ 17 cases (14.7%): Ⅰ A period in 5 cases, Ⅰ B period in 12 cases. There were 42 cases (36.2%) in stage Ⅱ: 11 cases in stage ⅡA and 31 cases in stage ⅡB. Stage Ⅲ 57 cases (49.1%): stage Ⅲ A 50 cases, stage Ⅲ B 7 cases. Total pneumonectomy in 9 cases (7.8%), lobectomy in 97 cases (83.6%), wedge resection or segmentectomy in 10 cases (8.4%). The 5-year survival rate was 65.3% in stage Ⅰ, 42.6% in stage Ⅱ and 18.7% in stage Ⅲ (P <0.05). The patients with stage I, II and III disease-free survival time were (61.7 ± 3.5) months, (44.8 ± 3.7) months, (28.9 ± 2.6) months (F = 8.741, P = 0.005) The survival time was (66.3 ± 2.7) months, (54.6 ± 1.8) months and (32.7 ± 2.4) months respectively (F = 4.941, P = 0.036). Forty patients (40.5%) had perioperative complications and the perioperative mortality rate was 1.7%. There was no statistically significant difference in postoperative survival between patients with and without preoperative cardiopulmonary vascular disease. Conclusion For elderly patients over the age of 70 with lung cancer, preoperative cardiopulmonary vascular disease is generally not a taboo surgery. Emphasis on preoperative cardiopulmonary brain function assessment, select the appropriate surgical approach, access to good long-term survival.