| Purpose: By comparing the status in perioperative stage and the survival rate in 1 year, 2 years and 3 years after operation of senile patients with non-small cell lung cancer who had lobectomy and lung wedge resection, review of the influence on patient survival condition of two different surgical methods, which could serve as the reference for the choice of elderly patients with lung cancer operation method in the future. Methods: From October 2005 to February 2012, a total of 60 cases of lung cancer patients were selected in the Thoracic Surgery Department, the Fourth Hospital of Hebei Medical University. These patients were confirmed for non-small cell lung cancer in postoperative pathology whose age were over 70. Among those there were 46 males and 14 females. The pathologic types, 23 cases of adenocarcinoma, 29 cases of squamous cell carcinoma, 7 cases of adenocarcinoma squamous carcinoma, and 1 mucous epidermoid carcinoma, The patients were divided into two groups. There are 7 cases of left upper lobe wedge resection, 5 cases of the left lower lobe lung wedge resection, 9 cases of wedge of the upper lobe, 4 cases of lower lobe right lung wedge resection in. Lobectomy group is consist of 35 cases. There are 11 cases of left upper lobe resection in, 6 cases of left lower lobe resection, 14 cases of the upper lobe, 4 cases of right lung lower lobe resection, 16 cases of adenocarcinoma, 16 cases of squamous cell carcinoma and 3 cases of gland scale. The chosen patients were those whose ①age > 70, ②the preoperative CT was tumor diameter < 5 cm, ③preoperative CT shows no enlargement of mediastinal lymph nodes, postoperative pathology is T1-2N0-1M0, ④ lung function FEV1 > 1.5L, cardiac ejection fraction > 55%. Complications criteria: ① pleural effusion: all the patients enrolled in took X ray examination to determined atelectasis, pneumothorax or pleural effusion on the second day after surgery, if necessary, chest CT. ②Respiratory failure diagnosis depends on arterial blood gas analysis, the main indicators are Pa O2 and Pa CO2. Resting arterial oxygen status breathing air(Pa O2) <60mm Hg and arterial carbon dioxide tension(Pa CO2)> 50 mm Hg defined as type Ⅱrespiratory failure. The single arterial oxygen pressure decreasing defined as type I respiratory failure. ③Imaging studies are the most accurate and valuable tools for pulmonary embolism(PE) diagnosis, including: chest X-ray, pulmonary perfusion / ventilation imaging, cardiac color Doppler ultrasound, MRI, CT, pulmonary angiography etc. ④The diagnostic criteria for atrial fibrillation is cardiac more than 100 beats / min, ECG showed cardiac arrhythmia absolutely, P wave disappeared, replaced by f wave. Before surgery, all of the patients were performed the following check: enhanced CT on the head, chest and abdomen, the whole body bone scan, electronic bronchoscope, electrocardiogram, heart function, pulmonary function and routine preoperative laboratory tests. All of the patients with preoperative practiced cough and sputum. Preoperative patients with chronic bronchitis and emphysema took bronchial spasmolysis medicine, expectorant and anti-inflammatory drugs. Patients with high blood pressure needed to control the blood pressure in 140-160/80-90 mm Hg and to stopped using anticoagulant blood activating drugs 7 days before surgery. Diabetic patients with preoperative took glucose-lowering drugs or subcutaneous insulin injections to control the fasting blood glucose under 8mmol/L.The tumor staging was refered to the period of clinical of the non-small cell lung cancer(The year of 2010 AJCC 7th). After surgery, the status such as complications with or without perioperative, flow conditions and the chest closed drainage tube time were recorded. They were followed up for 3 years. This study adopts SPSS13.0 software for statistical analysis. Measured data are displayed by mean value and standard deviation(X+S), chi-square test and Mann-Whitney Test, respectively analyze and compare the date of age, gender, flow rate and incidence of complications and survival data of 1 year, 2 years and 3 years, take P= 0. 05. Results:1 The statistical analysis of surgical patient’s age of two groups showed that: lung wedge group: 73.48±2.97, lobectomy group: 75.17 ± 4.04. The difference was not statistically significant.(t=-1.776,P=0.081, t test)2 The statistical analysis of sex ratio for two surgical patients groups showed that: lung wedge group: male/female= 21/4, lobectomy group: male/female=25/10. The difference was not statistically significant.(c2 = 1.288, P = 0.256, chi-square test)3 The statistical analysis of drainage of two surgical patients groups after surgical showed that: lung wedge group: 1028.4±611.34; lobectomy group: 1528.42±694.41. the drainage of lobe wedge resection group less than that of lobectomy group, and the difference was statistically significant.(Z=-3.202,P=0.001, Mann-Whitney Test)4 The statistical analysis of thoracic drainage tube indwelling time of two surgical patient groups after surgical showed that: lung wedge group: 6.24±3.3, lobectomy group: 8.2±2.77, the thoracic drainage tube indwelling time in lobe wedge group is shorter than that in lobectomy group, and the difference was statistically significant.(Z=-2.909,P=0.004, Mann-Whitney Test)5 The statistical analysis of perioperative complications of two surgical patient groups after surgical showed that: lung wedge group: complications / no complications = 5/20, the complication rate was 20%; lobectomy group: complications / no complications = 12/23, the complication rate was 34.2%, and the difference was statistically significant.(c2=1.466,P=0.226, chi-square test)6 The constituent ratio of two surgical pathology patient groups: the difference of constituent ratio between pulmonary wedge resection and lobectomy group was not statistically significant.(c2= 3.784, P = 0.268, chi-square test)7 Survival analysis of two surgical groups of patients: pulmonary wedge resection group: 1-year survival rate was 88%, 2-year survival rate was 68%, 3-year survival rate was 64%, with an average survival time of 63.64(month); lobectomy group : 1-year survival rate: 94.3% 2-year survival rate was 77.1%, 3-year survival rate was 74.3%, with an average survival time of 59.38(month), the difference of survival rate between two surgical groups was not statistically significant.(c2= 0.128, P = 0.721, Kaplan-Meier method) Conclusions:1 The postoperative drainage of pulmonary wedge resection group less than that of lobectomy group.2 The drainage tube indwelling time after thoracic of pulmonary wedge resection group was shorter than the lobectomy group.3 The incidence of postoperative pulmonary complications of wedge resection group lower than that of lobectomy group.4 The survival rate of pulmonary wedge resection group,after 1 year、2 years、3 years, was lower than that of lobectomy group, with a little difference, the difference was not statistically significant. |
PDF Full Text Request