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目的 通过分析影响高龄肺癌患者术后并发症发生的因素 ,探讨高龄肺癌手术病例的选择 ,根据每个病人的情况制订具体的手术方案 ,减少并发症的发生。方法 1989年至 1998年期间 2 0 2例高龄肺癌病例手术前后全部资料的回顾性分析。结果 手术死亡率 0 .99%。术后并发症总发生率为 42 .6 %,其中呼吸衰竭 15例 ( 7.43%) ,心律失常 43例 ( 2 3.2 9%) ,其它并发症 30例 ( 14 .85 %)。其中 12 8例有重度吸烟 ,10 3例有慢支病史 ,43例体型肥胖 ,肺功能 81例FEV1<6 0 %、40例FEV1<1.5L、16例MVV <6 0 %、18例VC <6 0 %,14 1例术前无预防性抗菌素应用 ,78例术后气管内没用药和2 1例术前动脉血气分析异常患者术后并发症明显增加。结论 高龄不是手术的禁忌症 ,如估计能根治的肺癌 ,无重度吸烟和慢支史、体型正常、肺功能无严重减低、重要脏器无严重病变可选择手术治疗 ,并通过预防性抗菌素应用和术后气管内用药减少术后并发症的发生。对于老年病人手术应以肺叶切除为主 ,袖形肺叶切除是既减少功能损失又能达到根治目的的术式。呼吸功能严重降低患者可行肺段或肺楔行切除 ,不能轻易放弃手术机会。
Objective To analyze the factors influencing the postoperative complications of elderly patients with lung cancer and to explore the options of surgery for elderly patients with lung cancer and to formulate specific surgical plans according to each patient’s condition so as to reduce the incidence of complications. Methods A retrospective analysis of all the data of 202 elderly patients with lung cancer before and after operation between 1989 and 1998 was conducted. Results The operative mortality rate was 0.99%. The total incidence of postoperative complications was 42.6%, including respiratory failure in 15 cases (7.43%), arrhythmia in 43 cases (23.29%) and other complications in 30 cases (14.85%). Among them, 12 8 had severe smoking, 103 had chronic bronchitis, 43 had obesity, 81 had FEV1 <60% of lung function, 40 had FEV1 <1.5L, 16 had MVV <60% and 18 had VC < Preoperative non-prophylactic antibiotics were used in 61 cases, 78 cases of postoperative intratracheal intubation and 21 cases of abnormal arterial blood gas analysis before surgery were significantly increased postoperative complications. Conclusions Elderly is not a contraindication for surgery. For example, it is estimated that lung cancer can be treated without history of smoking and chronic bronchitis. Normal body size, no serious decrease of lung function, no serious disease of vital organs can be treated by surgery. Through preventive antibiotic application and Post-tracheal medication to reduce the incidence of postoperative complications. Surgery for elderly patients should be the main lobectomy, sleeve lobe resection is not only to reduce functional loss but also to achieve the purpose of radical surgery. Respiratory function is severely reduced in patients with feasible lung segment or wedge resection, can not easily give up the chance of surgery.