65岁及以上老年人胸腺手术安全性评估  

Safety evaluation of thymectomy in elderly patients aged 65 years and over

作　　者：焦鹏[1] 吴凡隽 刘雨星 吴江宇 孙耀光[1] 田文鑫[1] 吴青峻[1] 马超[1] 于瀚博 黄川 李东航 佟宏峰[1] Jiao Peng;Wu Fanjuan;Liu Yuxing;Wu Jiangyu;Sun Yaoguang;Tian Wenxin;Wu Qingjun;Ma Chao;Yu Hanbo;Huang Chuan;Li Donghang;Tong Hongfeng(Department of Thoracic Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Medicine,Peking University,Beijing,China)

机构地区：[1]北京医院胸外科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]北京大学医学部,北京100730

出　　处：《中华老年医学杂志》2023年第5期546-551,共6页Chinese Journal of Geriatrics

摘　　要：目的评估65岁以上老年患者进行胸腺手术的安全性。方法收集2011年11月到2022年3月在北京医院胸外科进行胸腺或胸腺瘤切除的696例患者,以65岁为界分成两组,记录两组患者术前病程、重症肌无力(MG)分期、溴吡斯的明用量、ASA(美国麻醉医师协会)评分、手术方式、术中出血、术后引流情况、术后并发症发生及Clavien-dindo评分(CDC)、MG危象发生情况等指标,并进行统计学分析两组是否存在差异。结果共纳入696例患者,男364例,女332例,年龄15~86岁,平均49.1岁。胸腺瘤患者为309例,MG患者为565例,两者同时存在的为178例。老年组(≥65岁)124例,非老年组(<65岁)572例。老年组胸腺瘤发生率更高(54.8%和42.1%,χ^(2)=6.664,P=0.010);但是MG的发生率较低(67.7%和84.1%,χ^(2)=17.827,P<0.001);老年组ASA评分高于年轻组(χ^(2)=52.372,P=0.000),术前通气功能一秒用力呼气量(FEV1),FEV1/用力肺活量(FVC),也明显低于非老年组(z=8.187,4.580,均P=0.000)。术后前3 d引流量和术后引流管时间老年组均显著大于非老年组(P=0.018,P=0.003)。老年组在术后肌无力危象的发生率高于非老年组(P=0.034)。术后并发症的发生率两组无统计学差异,但是将其进行Clavien-dindo分级后,老年组评分高于非老年组(P=0.003)。虽然老年组的ASA评分和Clavien-dindo评分均高于非老年组,但是这两者之间并无相关性。结论老年患者虽然术前ASA评分、肺功能等差于年轻组,术后MG危象的发生率更高,术后总的并发症的发生率并不高,但是Clavien-dindo高于年轻组,经过仔细术前评估,加强围手术期管理大多数老年患者可以安全的进行胸腺手术。Objective To evaluate the safety of thymic surgery in patients aged 65 years and over.Methods A total of 696 patients who underwent thymectomy/thymoma resection in the Department of Thoracic Surgery of Beijing Hospital from November 2011 to March 2022 were collected and divided into two groups according to the age of 65 years old.The preoperative course of disease,MG stage,dosage of pyridostigmine bromide,American College of Anesthesiologists(ASA)score,surgical method,intraoperative bleeding,postoperative drainage,postoperative complications,Clavien-dindo score(CDC),and myasthenic crisis were recorded and statistically analyzed.Results A total of 696 patients were enrolled,including 364 males and 332 females,aged 15~86 years,with an average age of 49.1 years.There were 309 patients with thymoma,565 patients with MG,and 178 patients with both.There were 124 cases in the elderly group(≥65 years old)and 572 cases in the non-elderly group(<65 years old).The incidence of thymoma was higher in the elderly group(54.8%versus 42.1%,χ^(2)=6.664,P=0.010),while the incidence of MG was lower(67.7%versus 84.1%,χ^(2)=17.827,P<0.001).The ASA score of the elderly group was higher than that of the non-elderly group(χ^(2)=52.372,P=0.000),and the preoperative ventilation function FEV1 and FEV1/FVC were also significantly lower than those of the non-elderly group(z=8.187,4.580,P=0.000 for all).The drainage volume in the first 3 days after operation and postoperative drainage tube time in the elderly group were significantly higher than those in the non-elderly group(P=0.018,P=0.003).The incidence of postoperative myasthenia crisis in the elderly group was higher than that in the non-elderly group(P=0.034).There was no significant difference in the incidence of postoperative complications between the two groups,but after Clavien-dindo classification,the score of the elderly group was higher than that of the non-elderly group(P=0.003).Although the ASA score and Clavien-dindo score of the elderly group were both higher than those o

关 键 词：胸腺瘤 胸腺切除术 手术后并发症 

分 类 号：R736.3[医药卫生—肿瘤]