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目的探讨75岁以上高龄患者采用胸腔镜手术治疗的安全性和适应证。方法分析2006年1月至2012年10月采用胸腔镜手术治疗的31例75岁以上高龄患者的临床资料,其中肺叶切除+纵隔淋巴结清扫7例,肺楔形切除+区域淋巴结切除9例,肺楔形切除10例,胸膜活检和胸膜腔固定术5例。结果围手术期死亡患者1例。并发症发生率为48.3%(15/31),包括肺部感染、心律失常、肺不张、心脏衰竭和呼吸衰竭等。手术后病理检查16例患者为早期原发性肺癌,其1年生存率和3年生存率分别为91.6%和62.5%。结论对经过选择的75岁以上高龄患者行胸腔镜手术安全可行,其适应证包括早期周围型肺癌、性质未明的孤立性肺周围结节、原因不明或恶性胸腔积液以及为明确病理的单纯活组织检查,而对于早期高龄肺癌患者建议采用肺部分切除+区域淋巴结清扫治疗。
Objective To investigate the safety and indications of thoracoscopic surgery in elderly patients over 75 years old. Methods The clinical data of 31 patients aged 75 years and older undergoing thoracoscopic surgery from January 2006 to October 2012 were analyzed. Among them, lobectomy + mediastinal lymph node dissection in 7 cases, pulmonary wedge resection + regional lymph node dissection in 9 cases, Excision of 10 cases, pleural biopsy and pleural fixation in 5 cases. Results Perioperative death in 1 patient. The complication rate was 48.3% (15/31), including pulmonary infection, arrhythmia, atelectasis, heart failure and respiratory failure. Sixteen patients with pathologically confirmed primary lung cancer had a one-year and three-year survival rates of 91.6% and 62.5%, respectively. Conclusions Thoracoscopic surgery is safe and feasible for selected aged patients over 75 years of age. The indications include early peripheral lung cancer, solitary pulmonary nodules of unknown nature, unexplained or malignant pleural effusion, and simple clear pathology Tissue examination, and for advanced lung cancer patients recommended partial lung resection + regional lymph node dissection.