老年肺癌的诊治  

DIAGNOSIS AND TREATMENT OF LUNG CANCER IN THE ELDERLY

作　　者：陈海涛[1] 任健[1] 车嘉铭[1] 陈中元[1] 邱维诚[1] 

机构地区：[1]上海第二医科大学附属瑞金医院心胸外科,200025

出　　处：《老年医学与保健》2005年第1期37-38,60,共3页Geriatrics & Health Care

摘　　要：目的对65岁以上肺癌患者进行回顾性分析。方法自1994至2003年,我们共统计934例肺癌手术病人,其中65岁以上患者共355例,占38%,手术切除率为98.6%。结果平均年龄71.4±5岁(65～81岁),其中男性293例(82.5%),女性62例(17.5%)。手术包括:全肺切除26例,肺叶切除(包括双叶切除)286例,袖状切除27例,隆凸切除术5例,电视胸腔镜辅助下楔形切除6例,剖胸探查5例。术后病理为鳞癌185例,腺癌133例,大细胞癌17例,小细胞肺癌6例,其余的占14例。Ⅰ期26例,Ⅱ期6例,Ⅲ期323例。结论常规胸片检查可作为早期高危人群中检测肺癌的手段之一。虽然老年患者术后伴有高风险并发症,但手术仍然是治疗非小细胞肺癌(Ⅰ￣Ⅲ期)的主要手段,年龄并非是一个有意义的预后因素。本组病人中合并COPD者占37.6%。如病人的FEV1>1.6L或Vo2max>10ml/kg·min或能登上三楼(11米高),手术是安全的。总之,老年患者严格掌握手术适应证和做好术前准备,其手术并发症未显著增高。以手术为主的综合治疗能有效提高老年肺癌患者的生存期。Objective To analyze restropectively lung cancer patients over 65 years of age. Methods We collected 934 operated cases of lung cancer patients from 1994 to 2003. There were 355 patients over 65 years of age, occupying 38%. Resectable rate of operation was 98.6%. Results The mean age was 71.4±5 years(65￣81 yrs.). Among them, there were 293 males (92.5%) and 62 females (17.5%). Operations included: 26 cases of pneumonectomy, 286 cases of lobectomy (including resection of double lobes),27 cases of sleeve-shaped resection, 5 cases of resection of the carina, 6 cases of wedgeshaped resection under the aid of television-thoracoscope, and 5 ccases of thoracotomy examination. Post-operative pathological exami- nation revealed 185 cases of sqquaamous cell carcinoma, 133 cases of adenocarcinoma, 17 cases of large cell carcinoma, 6 cases of smsll cell carcinoma, and 14 cases of other types. In regard to clinical stages, 26 cases belonged to stage I, 6 cases belonged to stage Ⅱ and 323 cases, stage III. Conclusions Routine chest film examinationcan be used as one of the methods to detect lung cancer among the high risk population. Though aged patients have high risk of post-operative complications, yet surgical operation remains to be the chief measures for the treatment of small cell lung carcinoma(Ⅰ-Ⅲ stages). Age is not a meaningful factor of prognosis. 37.6% patients in this group have COPD as complications. If the patient's FEV1>1. 6 L or VO2> to ml/Kg· min, or the patient is able to walk upward to the 3rd. flat(11 meters in height), operation is considered to be safe. In general, for elderly patients, sttrictly handle operative indications and well arrange pre-operative preparations, there will be no significant increase of surgical complications. Surgery as the chief method in the comprehensive treatment can prolong the survival time for aged patient of lung cancer.

关 键 词：老年人 肺肿瘤/外科手术 

分 类 号：R734.2[医药卫生—肿瘤]