摘要
目的探讨年龄80岁及以上的临床I期非小细胞肺癌患者行肺叶切除的安全性，对比胸腔镜手术和开放手术疗效，分析术后并发症及生存率影响因素。方法收集2006年1月至2016年12月上海市胸科医院行肺叶切除术的80岁及以上非小细胞肺癌患者资料，包括临床基本资料、术后并发症和生存情况。结果162例临床I期80岁及以上患者行肺叶切除手术，其中胸腔镜肺叶切除术98例（胸腔镜组），开放肺叶切除术64例（开放组）。胸腔镜组并发症发生率（14．3％对28．1％，P=0．03），术后胸管引流时间[（3．5±1．5）天对（4．9±2．0）天，P=0．04]，术后住院时问[（5．5±2．1）天对（7．8±3．5）天，P=0．04]均少于开放手术组。患者的5年生存率62％，病理I、Ⅱ和Ⅲ期患者5年生存率为64．5％、38．1％和20．1％。病理I期和Ⅱ、Ⅲ期患者总生存率差异显著（P：0．001）。多因素logistic回归分析显示，开放手术是术后发生并发症的独立危险因素（OR=1．94，95％CI1．214-5．135，P=0．03）。多因素Cox回归分析显示，病理Ⅱ～Ⅲ期（OR=2．01，95％CI1．453-5．865，P=0．03）和美国麻醉医师协会（ASA）分级为3—4（OR=1．81，95％CI1．188-4．015，P=0．04）是术后5年生存率的独立危险因素。结论对于术前严格筛选的I期非小细胞肺癌患者行肺叶切除手术安全，生存率较高；胸腔镜手术术后并发症较少，术后胸管引流和住院时间短。开放手术是80岁及以上临床I期肺癌患者术后并发症的独立预测因子；病理分期和ASA分级是其术后生存率的预测因子。
Objective As the population ages, clinicians are increasingly confronted with octogenarians with early-staged non-small cell lung cancer（NSCLC）. We reviewed the outcomes of octogenarians who underwent lobectomy for clinical stage I NSCLC, to determine whether there was a benefit to the VATS approach in this group, and to analysis the risk factors of complication and survival. Methods We conducted a retrospective single-institution review of patients age 80 years or greater who underwent lobectomy for NSCLC from January 2006 to December 2016. Clinical outcomes including complication rate and survival rate were analyzed. Results 162 octogenarians underwent lobectomy： 98 VATS and 64 through open thoracotomy. Compared with thoracotomy, VATS patients had fewer complications （ 14.3 % vs. 28. 1%, P = 0.03 ）, shorter length of tube duration [ （ 3.5±1.5 ） days vs. （4.9±2.0 ） days, P = 0.04 ], and shorter length of stay[ （ 5.5±2.1 ） days vs. （7.8±3.5 ） days, P = 0.04 ]. For patients with pathologic stage I disease, the 5-year overall survival was 64.5 % , for stage Ⅱ was 38.1% , and for stage m was 20.1%. The 5-year overall survival rates of pathological stage I and stage Ⅱ , Ⅲ are of significant differences（ P = 0. 001 ）. In a multivariate logistic regression analysis, the approach of thoracotomy emerged as an independent predictor of complication （ OR = 1.94, 95 % CI 1. 214 - 5. 135, P = 0.03 ）. In a multivariate COX regression analysis, pathological stage （ OR = 2.01, 95 % CI 1. 453 - 5. 865, P = 0.03 ） and ASA （ OR = 1.81, 95 % CI 1.188 - 4.015, P = 0.04 ） are independent predictors of over survival. Conclusion Octogenarians with NSCLC can undergo resection with low mortality and survival among stage I patients, which is comparable with the general lung cancer population. The VATS approach reduces morbidity in this age demographic, resulting in shorter length of tube duration and shorter stay, while the approach of thoracoto-my is an independent predictor of complicat
作者
仲晨曦
范利民
赵珩
Zhong chenxi;Fan limin;Zhao heng(Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shangha)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2018年第4期216-220,共5页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
高龄
肺叶切除
胸腔镜手术
开胸手术
Octogenarian Lobectomy Thoracoscopy/VATS Thoracotomy
