Ⅰb期老年肺癌患者不同术式的对比研究

发布时间：2018-06-03 22:41

本文选题：肺癌 + 老年　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:对Ⅰb期老年肺癌患者的不同术式进行对比,比较不同手术方式的近期手术效果和术后复发及远期生存情况。方法:为保证足够的随访期,本研究病例收集的时限为2011年1月至2013年12月,患者均在大连医科大学附属第一医院胸外科行手术治疗,且术后病理证实为肺癌,这样的老年患者共126例。对患者的年龄、性别、术前FEV1、吸烟史、手术时长、术中失血量、胸管引流时间、术后恢复时间、总住院时间、术后病理的病理分级、病理类型、T分期、胸膜侵犯以及术后化疗等数据进行统计分析。具体为:对不同术式组的性别、年龄、吸烟史、病理分级、病理分型、T分期、胸膜侵犯、术后并发症进行卡方检验,对患者手术时长、术中失血量、胸管引流时间、术后住院时间、总住院时间等数值变量进行T检验,分别以复发时间及生存期作为最终观察结果,运用Kaplan-Meier法对所有入组病例进行单因素分析,并绘制生存曲线。结果:126例老年肺癌患者中,男性患者总共有60例,占总手术人数的47.6%,女性患者共有66例,占总手术人数的52.4%。所有入组患者的中位年龄为74岁,年龄70-74岁的患者65例,74岁以上的患者61例。20例患者既往有吸烟史,106例患者既往无吸烟史。术前肺功能评估FEV1占预计值百分比大于90%的患者为63例,小于或等于90%的患者为63例。89例患者行肺叶切除,占总手术人数的71%,37例患者行亚肺叶切除,占总手术人数的29%。行肺叶切除的患者平均手术时间为144.9分钟,行亚肺叶切除的患者平均手术时长111.2分钟。在术中平均失血量对比方面,行肺叶切除的患者平均为68.6ml,行亚肺叶切除的患者平均为33.6ml。行肺叶切除的患者术后平均带管时间为4.9天,行亚肺叶切除的患者术后平均带管时间为3.6天。行肺叶切除的患者自手术之日起至出院(术后恢复时间)平均为7.4天,行亚肺叶切除的患者自手术之日起至出院平均为6.9天。行肺叶切除的患者总住院时间平均为14.3天,略高于行亚肺叶切除患者的13.5天。行肺叶切除的患者术后有并发症的为24例,占比为26.9%,行亚肺叶切除的患者术后有并发症的为5例,占比为13.5%。行肺叶切除的患者术后复发率为26%,行亚肺叶切除的患者术后复发率为22%,其中高、中、低分化的复发率分别为11%、20%和50%。腺癌患者的复发率为21%,鳞癌患者的复发率为53%,大细胞神经内分泌癌只有一例,目前健在,无复发;并且小细胞癌也只有一例,仍健在,无复发,此处不予讨论,因为例数太少无代表意义。T1a、T1b、T1c和T2a期的复发率分别为0%、12%、26%和58%。有胸膜侵犯和无胸膜侵犯的复发率分别为67%和21%。老年肺癌患者术后整体五年生存率为78.6%,其中行肺叶切除的老年肺癌患者五年生存率为78%,行亚肺叶切除的老年肺癌患者五年生存率为84%,其单因素分析结果无统计学差异(P=0.292)。再筛选出传统意义上影响患者预后的因素如:年龄、病理分级、病理类型、T分期和胸膜侵犯行Kaplan-Meier法单因素分析,结果显示,有意义的变量为病理分级(P=0.000)、病理类型(P=0.038)、T分期(P=0.001)和胸膜侵犯(P=0.004)。其中高、中、低分化的五年生存率分别为95%、84%和56%。腺癌和鳞癌的五年生存率为83%和28%。T1a、T1b、T1c和T2a期的五年生存率分别为100%、90%、79%和50%。有胸膜侵犯和无胸膜侵犯的复发率分别为67%和21%。结论:1.对于Ⅰb期老年肺癌患者,T分期是影响患者手术方式的危险因素之一,行亚肺叶切除的患者在手术时长、术中失血量及胸管引流时间方面均优于行肺叶切除的患者。2.对于Ⅰb期老年肺癌患者,病理分级、病理类型、T分期和胸膜侵犯影响患者预后与复发,行亚肺叶切除的与肺叶切除的患者有着相似的复发率和远期预后。
[Abstract]:Objective: To compare the different surgical procedures for the elderly patients with lung cancer in phase I B, compare the recent operation effect, postoperative recurrence and long-term survival of different surgical methods. Methods: to ensure sufficient follow-up period, the time limit of this case collection is from January 2011 to December 2013, all of the patients are in the Department of thoracic surgery, the First Affiliated Hospital of Dalian Medical University. The age, sex, preoperative FEV1, smoking history, operation time, postoperative recovery time, postoperative recovery time, total hospitalization time, postoperative pathological grade, pathological type, T staging, pleural invasion, and postoperative chemotherapy were performed on 126 elderly patients with lung cancer. The results were as follows: the gender, age, smoking history, pathological classification, pathological classification, T staging, pleural invasion, and postoperative complications were checked by chi square, and T tests were performed on the patient's length of operation, the amount of blood loss, the drainage time of the thoracic tube, the time of postoperative hospitalization, and the total hospitalization time. As the final observation result, the Kaplan-Meier method was used to make a single factor analysis of all the cases in the group and draw a survival curve. Results: among the 126 elderly patients with lung cancer, there were 60 cases in the male patients, 47.6% of the total number of operations, 66 cases in the female patients, and the median age of all the total number of 52.4%. patients was 74 years old. There were 65 cases of age 70-74 years old, 61.20 patients over 74 years old, 106 patients who had no history of smoking, 63 cases of preoperative pulmonary function assessment FEV1 accounted for the estimated percentage of more than 90%, and 63 cases of.89 patients who were less than or equal to 90% were treated with pulmonary lobectomy, 71% of the total number of operations, and 37 patients with sublung. The average operation time of lobectomy in patients with 29%. in total number of lobectomy was 144.9 minutes, and the average operation time of the patients undergoing sublobectomy was 111.2 minutes. In the mean of the average blood loss, the average of the lobectomy patients was 68.6ml, and the average number of lobectomy in the patients with sublobectomy was 33.6ml. after the resection. The average time of the tube was 4.9 days, and the average time for the postoperative sublobectomy was 3.6 days. The average length of the patients who underwent lobectomy from the day of operation to the discharge (recovery time) was 7.4 days, the average of the patients who underwent sublobectomy from the day of operation to discharge was 6.9 days. The average length of hospitalization for the patients with lobectomy was 14.3. 13.5 days, slightly higher than the 13.5 days of sublobectomy. The postoperative complications of lobectomy were 24, 26.9%, and 5 patients with sublobectomy, 26% of the patients who had lobectomy, and 22% of the patients with subpulmonary lobectomy, of which the postoperative recurrence rate was 22%, high, middle, The recurrence rate of low differentiation was 11%, the recurrence rate of the 20% and 50%. adenocarcinoma was 21%, the recurrence rate of the squamous cell carcinoma was 53%, there was only one case of large cell neuroendocrine carcinoma, and there was only one case of small cell carcinoma, still alive, no relapse, no discussion here, because the number of cases was too few unrepresentative.T1a, T1b, T1c and T2a period. The recurrence rates were 0%, 12%, 26% and 58%. with the recurrence rate of pleural invasion and non pleural invasion respectively 67% and 78.6% for the five year survival of the elderly patients with lung cancer in 21%.. The five year survival rate of the elderly lung cancer patients with lobectomy was 78%, and the survival rate of the elderly lung cancer patients with sublobectomy for five years was 84%, and the single factor analysis of lung cancer patients was 84%. There was no statistical difference (P=0.292). The factors that traditionally affect the prognosis of patients such as age, pathological grade, pathological type, T staging and pleural invasion were analyzed by single factor analysis of Kaplan-Meier. The results showed that the significant variables were pathological classification (P=0.000), pathological type (P=0.038), T stage (P=0.001) and pleural invasion (P=0.004). The high, middle, and low differentiated five year survival rates were 95%, 84% and 56%. adenocarcinoma and squamous cell carcinoma five year survival rates were 83% and 28%.T1a, T1b, T1c and T2a five year survival rates were 100%, 90%, 79% and 50%. with pleural and non pleural invasion recurrence rates were 67% and 21%. respectively: 1. for stage I B stage elderly lung cancer patients were affected by T staging One of the risk factors for the surgical procedure was that the patients who underwent sublobectomy were superior to the patients undergoing lobectomy for long, intraoperative blood loss and thoracic duct drainage..2. for patients with lung cancer in phase I B, pathological classification, pathological type, T staging and pleural invasion and recurrence, sublobectomy with lobectomy and lobectomy. Resected patients had similar recurrence rate and long-term prognosis.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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