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目的总结60岁以上肺癌患者的外科治疗经验。方法回顾性分析2004年1月至2005年6月间手术治疗223例60岁以上肺癌病例,其中左全肺切除6例(2.7%),右全肺切除2例(0.9%),肺叶切除195例(87.4%),支气管袖状切除8例(3.6%),双袖1例(0.4%),肺段切除2例(0.9%),肺楔形切除9例(4.0%)。结果本组术后死亡1例,死亡率0.4%,死于呼吸衰竭。出现其他并发症130例,占58.3%。其中窦性心动过速38例,占17.0%;房颤25例,占11.2%;房早8例,占3.6%;高血压17例,占7.6%;痰多致呼吸道不畅低氧血症37例:其中23例(10.3%)经鼻导管给氧或面罩给氧,鼓励患者多咳嗽排痰后,血氧恢复正常;14例(6.3%)经纤支镜吸痰后,血氧恢复正常;肺部感染2例(0.9%),肺不张1例(0.4%),Ⅲ度漏气1例(0.4%),经积极治疗,均痊愈出院。结论60岁以上肺癌患者外科手术治疗是安全的,强围术期管理可以预防或减少术后并发症,降低死亡率。
Objective To summarize the experience of surgical treatment of lung cancer in patients over 60 years old. Methods A retrospective analysis of 223 cases of lung cancer over the age of 60 from January 2004 to June 2005 were performed, of which 6 cases were left pneumonectomy (2.7%), 2 cases were right pneumonectomy (0.9%), and 195 cases were lobectomy 8 cases (3.6%) had bronchial sleeve resection, 1 case had double sleeves (0.4%), 2 cases had segmentectomy (0.9%) and 9 cases had wedge resection (4.0%). Results This group of patients died in 1 case, the mortality rate was 0.4%, died of respiratory failure. Other complications occurred in 130 cases, accounting for 58.3%. Among them, 38 cases were sinus tachycardia, accounting for 17.0%; 25 cases were atrial fibrillation, accounting for 11.2%; 8 cases were early as early as possible, accounting for 3.6%; 17 cases were hypertension, accounting for 7.6% Thirty-seven patients (23%) underwent oxygenation via nasal cannula or masks. Patients were encouraged to cough and expectoration, and blood oxygen returned to normal. Fourteen patients (6.3% 2 cases (0.9%) had pulmonary infection, 1 case (0.4%) had atelectasis, and 1 case (Ⅲ%) had atelectasis. After active treatment, all cases were cured. Conclusion Surgical treatment of lung cancer patients over 60 years old is safe. Perioperative management can prevent or reduce postoperative complications and reduce mortality.