本文選題：肺癌 + 老年��； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:對Ⅰb期老年肺癌患者的不同術(shù)式進(jìn)行對比,比較不同手術(shù)方式的近期手術(shù)效果和術(shù)后復(fù)發(fā)及遠(yuǎn)期生存情況。方法:為保證足夠的隨訪期,本研究病例收集的時限為2011年1月至2013年12月,患者均在大連醫(yī)科大學(xué)附屬第一醫(yī)院胸外科行手術(shù)治療,且術(shù)后病理證實為肺癌,這樣的老年患者共126例。對患者的年齡、性別、術(shù)前FEV1、吸煙史、手術(shù)時長、術(shù)中失血量、胸管引流時間、術(shù)后恢復(fù)時間、總住院時間、術(shù)后病理的病理分級、病理類型、T分期、胸膜侵犯以及術(shù)后化療等數(shù)據(jù)進(jìn)行統(tǒng)計分析。具體為:對不同術(shù)式組的性別、年齡、吸煙史、病理分級、病理分型、T分期、胸膜侵犯、術(shù)后并發(fā)癥進(jìn)行卡方檢驗,對患者手術(shù)時長、術(shù)中失血量、胸管引流時間、術(shù)后住院時間、總住院時間等數(shù)值變量進(jìn)行T檢驗,分別以復(fù)發(fā)時間及生存期作為最終觀察結(jié)果,運用Kaplan-Meier法對所有入組病例進(jìn)行單因素分析,并繪制生存曲線。結(jié)果:126例老年肺癌患者中,男性患者總共有60例,占總手術(shù)人數(shù)的47.6%,女性患者共有66例,占總手術(shù)人數(shù)的52.4%。所有入組患者的中位年齡為74歲,年齡70-74歲的患者65例,74歲以上的患者61例。20例患者既往有吸煙史,106例患者既往無吸煙史。術(shù)前肺功能評估FEV1占預(yù)計值百分比大于90%的患者為63例,小于或等于90%的患者為63例。89例患者行肺葉切除,占總手術(shù)人數(shù)的71%,37例患者行亞肺葉切除,占總手術(shù)人數(shù)的29%。行肺葉切除的患者平均手術(shù)時間為144.9分鐘,行亞肺葉切除的患者平均手術(shù)時長111.2分鐘。在術(shù)中平均失血量對比方面,行肺葉切除的患者平均為68.6ml,行亞肺葉切除的患者平均為33.6ml。行肺葉切除的患者術(shù)后平均帶管時間為4.9天,行亞肺葉切除的患者術(shù)后平均帶管時間為3.6天。行肺葉切除的患者自手術(shù)之日起至出院(術(shù)后恢復(fù)時間)平均為7.4天,行亞肺葉切除的患者自手術(shù)之日起至出院平均為6.9天。行肺葉切除的患者總住院時間平均為14.3天,略高于行亞肺葉切除患者的13.5天。行肺葉切除的患者術(shù)后有并發(fā)癥的為24例,占比為26.9%,行亞肺葉切除的患者術(shù)后有并發(fā)癥的為5例,占比為13.5%。行肺葉切除的患者術(shù)后復(fù)發(fā)率為26%,行亞肺葉切除的患者術(shù)后復(fù)發(fā)率為22%,其中高、中、低分化的復(fù)發(fā)率分別為11%、20%和50%。腺癌患者的復(fù)發(fā)率為21%,鱗癌患者的復(fù)發(fā)率為53%,大細(xì)胞神經(jīng)內(nèi)分泌癌只有一例,目前健在,無復(fù)發(fā);并且小細(xì)胞癌也只有一例,仍健在,無復(fù)發(fā),此處不予討論,因為例數(shù)太少無代表意義。T1a、T1b、T1c和T2a期的復(fù)發(fā)率分別為0%、12%、26%和58%。有胸膜侵犯和無胸膜侵犯的復(fù)發(fā)率分別為67%和21%。老年肺癌患者術(shù)后整體五年生存率為78.6%,其中行肺葉切除的老年肺癌患者五年生存率為78%,行亞肺葉切除的老年肺癌患者五年生存率為84%,其單因素分析結(jié)果無統(tǒng)計學(xué)差異(P=0.292)。再篩選出傳統(tǒng)意義上影響患者預(yù)后的因素如:年齡、病理分級、病理類型、T分期和胸膜侵犯行Kaplan-Meier法單因素分析,結(jié)果顯示,有意義的變量為病理分級(P=0.000)、病理類型(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別為95%、84%和56%。腺癌和鱗癌的五年生存率為83%和28%。T1a、T1b、T1c和T2a期的五年生存率分別為100%、90%、79%和50%。有胸膜侵犯和無胸膜侵犯的復(fù)發(fā)率分別為67%和21%。結(jié)論:1.對于Ⅰb期老年肺癌患者,T分期是影響患者手術(shù)方式的危險因素之一,行亞肺葉切除的患者在手術(shù)時長、術(shù)中失血量及胸管引流時間方面均優(yōu)于行肺葉切除的患者。2.對于Ⅰb期老年肺癌患者,病理分級、病理類型、T分期和胸膜侵犯影響患者預(yù)后與復(fù)發(fā),行亞肺葉切除的與肺葉切除的患者有著相似的復(fù)發(fā)率和遠(yuǎn)期預(yù)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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2

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