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目的探讨老年非小细胞肺癌患者术后并发症的危险因素。方法选择2000年1月—2008年1月收治的非小细胞肺癌患者503例,根据患者的全身状况和病变部位、大小等选择合适的手术方式,包括肺叶切除术、双肺叶切除术和全肺切除术。前两年每2~3个月随访1次,之后每4~6个月随访1次。临床病理学参数进行Pearson’s Chi-squared检验或Fisher精确概率检验,独立危险因素运用多因素Logistic回归分析,生存率以生命表法计算。P<0.05为差异有统计学意义。结果两组间术后并发症的发生率(75岁以上组49.45%,75岁以下组40.04%)无明显差异。年龄并不是术后并发症的危险因素,而吸烟、术中失血量和淋巴结清扫是危险因素。75岁以上组5年总体生存率(51.65%)明显低于75岁以下组(68.93%)(P<0.05),但肺癌特异性死亡率在两组间却没有差异(P>0.05)。结论老年非小细胞肺癌患者的术后并发症与吸烟、失血量和淋巴结清扫有关,但与年龄无关。老年非小细胞肺癌患者不应视为不适合手术治疗。
Objective To investigate the risk factors of postoperative complications in elderly patients with non-small cell lung cancer. Methods 503 patients with non-small cell lung cancer admitted to our hospital from January 2000 to January 2008 were enrolled in this study. According to the general condition of the patient and the site and size of the lesion, appropriate surgical procedures including lobectomy, lobectomy and whole lung cut. Follow-up was performed every 2 to 3 months in the first two years and followed up every 4 to 6 months. The parameters of clinical pathology were tested by Pearson’s Chi-squared test or Fisher’s exact test. Independent risk factors were analyzed by multivariate logistic regression analysis. Survival rate was calculated by life table method. P <0.05 for the difference was statistically significant. Results The incidence of postoperative complications between the two groups (49.45% over 75 years and 40.04% under 75 years old) showed no significant difference. Age is not a risk factor for postoperative complications, smoking, intraoperative blood loss and lymph node dissection are risk factors. The overall 5-year survival rate (51.65%) of patients over 75 years old was significantly lower than that of patients under 75 years old (68.93%) (P <0.05). However, there was no difference in lung cancer-specific mortality between the two groups (P> 0.05). Conclusion The postoperative complications of elderly patients with non-small cell lung cancer are related to smoking, blood loss and lymph node dissection, but not to age. Elderly patients with non-small cell lung cancer should not be considered unsuitable for surgical treatment.