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目的:分析TNM分期、病理类型、年龄和手术方式与预后的关系,探讨在各影响预后因素中外科治疗手段的正确选择。方法:应用SPSS8.0统计软件,对237例肺癌患者资料建立数据库并进行统计分析,用寿命表法进行生存率分析。两组间生存率差异显著性检验用Logrank方法。结果:Ⅱb期以上肺癌总的5年生存率为49.8%,Ⅲa期仅为13.1%(P<0.01),Ⅲb和Ⅳ期肺癌均为0%,但伴颅内单发转移病灶手术治疗后平均生存期19个月。鳞癌5年生存率48.3%,腺癌和腺鳞癌分别为30.5%和13.3%(P<0.05和<0.01);小细胞肺癌为0;大细胞肺癌为60.2%。70岁以下肺癌患者肺楔形切除术5年生存率为0;肺叶切除术31.4%(P<0.01);全肺切除术18.2%(P<0.01);肺叶加支气管袖状切除术37.6%(P<0.01)。70岁以上肺癌患者肺楔形切除5年生存率33.4%,肺叶切除27.0%(P<0.05);全肺切除和肺叶加支气管袖状切除术3年生存率分别为20.2%和50.5%(P<0.01)。结论:Ⅱb期以上肺癌外科治疗应为首选;Ⅲa期应采用术前新辅助治疗的综合治疗;手术可作为Ⅲb和Ⅳ期肺癌姑息性治疗的手段;脑部单个转移病灶的肺癌不应为手术禁忌证。腺癌和腺鳞癌应以手术为主的综合性治疗;小细胞肺癌应以化疗为主的综合性治疗;透明细胞类型的大细胞肺癌应以手术为主的综合性治疗。70岁以下肺癌患者肺叶切除加?
OBJECTIVE: To analyze the relationship between TNM staging, pathological type, age, surgical approach and prognosis, and to explore the correct choice of surgical treatment in various prognostic factors. Methods: SPSS8.0 statistical software was used to establish a database of 237 patients with lung cancer and statistical analysis, survival rate analysis using life table method. The significant difference between the two groups was tested by Logrank method. Results: The overall 5-year survival rate was 49.8% in stage Ⅱb and 13.1% in stage Ⅲa (P <0.01), and 0% in stage Ⅲb and Ⅳ. However, the average 5-year survival rate Survival of 19 months. The 5-year survival rate was 48.3% in squamous cell carcinoma, 30.5% in adenocarcinoma and 13.3% in adenosquamous carcinoma (P <0.05 and <0.01), 0 in small cell lung cancer, and 60.2% in large cell lung cancer. The 5-year survival rate of lung wedge resection was 0 in lung cancer patients under 70 years of age; lobectomy was 31.4% (P <0.01); pneumonectomy was 18.2% (P <0.01); lobectomy plus bronchial sleeve resection was 37.6% (P <0.01). The 5-year survival rates of lung wedge resection and pulmonary lobectomy were 33.4% and 27.0% respectively (P <0.05). The 3-year survival rates of pneumonectomy and bronchial sleeve resection plus lobectomy were 20.2% and 50.5%, respectively (P < 0.01). Conclusions: Surgical treatment of stage Ⅱb and above lung cancer should be the first choice; stage Ⅲa should be treated with neoadjuvant therapy; surgery can be used as a palliative treatment for stage Ⅲb and Ⅳ lung cancer; Contraindications. Adenocarcinoma and adenosquamous carcinoma should be surgery-based comprehensive treatment; small-cell lung cancer should be chemotherapy-based comprehensive treatment; clear cell type of large-cell lung cancer should be surgery-based comprehensive treatment. Lung cancer patients under the age of 70 plus lobectomy plus?