摘要
目的:通过分析70岁以上肺癌患者的临床资料,总结高龄肺癌外科治疗和围术期处理的相关经验。方法:回顾性分析北京大学第三医院胸外科1997年11月至2007年11月手术治疗70岁以上肺癌患者95例,其中男70例,女25例;平均年龄73.5岁。术前根据患者肺功能检查第一秒用力呼气量(FEV1)、一氧化碳弥散量(DLCO)、超声心动左室射血分数(LVEF)、运动试验等结果评估其手术风险。在双腔气管插管全身麻醉下,行全肺切除3例,肺叶切除70例,肺部分切除20例,开胸探查2例。对于手术结束时出现低氧血症的12例患者延迟拔除气管插管,予呼吸机辅助通气以利于麻醉恢复期平稳过渡。采用β1受体阻滞剂和胺碘酮相结合治疗术后快速性心律失常。结果:根据pTNM分期,Ⅰ期患者占总体的41.2%。术后并发症发生率44.2%,无术中死亡,围术期死亡率4.2%。术前DLCO<60%预计值的患者,术后并发症发生率显著高于DLCO≥60%预计值的患者(P=0.004)。麻醉恢复期给予呼吸机支持的患者,围术期死亡率(P=0.02)和平均通气时间(P=0.032)显著低于麻醉恢复期未经呼吸机支持,术后因呼吸功能不全而二次气管插管的患者。β1受体阻滞剂和胺碘酮治疗术后快速性心律失常有效率达到94.1%。结论:高龄肺癌患者通过严格的心肺功能评估,选择适当的手术方式,积极防治术后并发症,可以获得相对良好的外科治疗效果。
Objective： To discuss the surgical treatment and perioperative management of lung cancer in senior patients. Methods： From November 1997 to November 2007, 95 patients over 70 years old （70 males and 25 females, with an average age of 73.5） with lung cancer received surgical treatment in our department. We retrospectively analyzed their medical records. Before surgery, these patients＇ forced expiratory volume in one second （FEV1）, diffusing capacity for carbon monoxide （DLCO）, and left ventricular ejection fraction （LVEF） were tested and an exercise test was performed to evaluate the surgical risk. Three patients received pneumonectomy, 70 patients had Iobectomy, 20 patients had limited pulmonary resection and 2 patients had exploratory thoracotomy. Postoperatively, 12 patients had delayed extubation because of hypoxemia and were supported by mechanical ventilation for a smoother recovery from anaesthesia. Postoperative tachyarrhythmia was treated with beta-1 receptor blocker and amiodarone. Results： According to the pTNM staging, 41.2% of the patients were of stage I. No patients died during the operation. The perioperative mortality rate was 4.2% and the postoperative morbidity was 44.2%. Compared with those patients who had DLCO≥60%, patients with DLCO〈60% had a remarkably higher rate of postoperative complications （P=0.004）. The postoperative mortality of patients assisted by mechanical ventilation during anaesthesia recovery was lower than that of those without mechanical ventilation assistance during anaesthesia recovery （P=-0.02）. Beta-1 receptor blocker and amiodarone successfully treated postoperative tachyarrhythmia in 94.1% of the patients that had it. Conclusion： Senior patients with lung cancer benefit from strict preoperative evaluation, the use of proper surgical procedures and active management of postoperative complications.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2008年第18期1024-1027,共4页
Chinese Journal of Clinical Oncology
关键词
高龄
肺癌
手术
围术期
Senior patient
Lung cancer
Surgery
Perioperative period
