全胸腔镜肺叶切除及纵隔淋巴结清扫术在治疗高龄非小细胞肺癌患者中的价值.pdfVIP

between the two groups were statistically significant (P=0.004,0.000,0.010).There was no significant difference in duration of surgery, volume of peri-operative bleeding, volume of blood transfusion, total post-operative drainage, length of hospital stay,and the use of painkiller (P0.05). The incidence of cardiovascular complications in the elderly group was higher （23.7% vs. 1.8%, P=0.001）.The metastasis lymph node rate of the elderly group was lower, with no statistical difference （4.2% vs. 8.6%, P=0.144）,so were N1 and N2 lymph node rates （3.4% vs. 84%,4.7% vs.8.0%,P=0.050,0.358）.The 1-year and 2-year survival rate was 96.4%,97.8% and 73.1%,78.1%,respectively （P=0.161）. Conclusions: With increasing age, background diseases of the elderly patients increase, and cardiopulmonary function declines. However, old age should not be the surgical contraindication. Based on the cardiopulmonary function evaluation,the elderly patients could tolerate VATS lobectomy and mediastinal lymph node dissection, which is the same as ones aged less than 70. There was no difference about early prognosis between the elderly and the non-elderly patients.Overall, VATS lobectomy and mediastinal lymph node dissection was a safe and feasible surgical strategy for the treatment of elderly patients with NSCLC. KEYWOEDS: Elderly Patients;Non-small Cell Lung Cancer;Video-assisted Thoracoscopic Surgery; Lobectomy;Mediastinal Lymph Node Dissection;Prognosis 6 引 言 目前，肺癌已成为世界范围内发病率和死亡率最高的癌症，超过50％的肺 4 癌患者年龄在65 岁以上，70 岁以上的占30％至40％。美国的流行病学资料显 示，在发达国家诊断肺癌时的男性中位年龄是69 岁，女性是67 岁5 。随着社会 人口的老龄化，老年肺癌的发病人数还会增加。老年肺癌患者治疗模式的选择是 临床肿瘤工作者最关注的问题之一，到底何种治疗方式最佳并获得更长的预后还 存在争议。 外科手术是治疗非小细胞肺癌(NSCLC)的重要手段之一。而高龄患者常因心 肺功能差、对开胸手术耐受性差、并发症多、死亡率高等原因而放弃手术治疗的 机会。电视胸腔镜手术(VATS)具有微创、安全、可行性高、术后恢复快、并发症 少等优点。目前 VATS 肺叶切除及纵隔淋巴结清扫术已成为治疗非小细