CAJ | 학술논문

背景与目的：老年食管癌发病率呈上升趋势。本研究旨在比较高龄老人和年轻老人两组胸段食管鳞癌患者临床病理资料、手术及术后情况，分析不同手术入路对高龄老年患者的影响。方法：回顾性分析2006年1月-2008年12月安徽医科大学附属省立医院胸外科收治的胸段食管鳞癌老年患者(60岁以上)371例。其中≥75岁的高龄老人53例，60~74岁的年轻老人318例，分别比较两组患者临床病理特征、手术情况、并发症及术后院内死亡率和平均住院时间，同时根据手术入路不同分为左进胸入路与右进胸入路，比较手术时间、术中出血量及术后并发症发生率等情况。结果：高龄老人组与年轻老人组相比术前合并症更多，术前ASA分级更高，术后并发症、住院时间及院内死亡率均明显增高，高龄老人组左胸入路较右胸入路术后并发症特别是肺部并发症更少(13.0% vs 40.0%)，差异有统计学意义(P<0.05)。结论：≥75岁的老年胸段食管鳞癌患者手术风险较大，可以通过选择相对简单的手术方式，减少术后并发症特别是肺部并发症的发生率。
배경여목적：노년식관암발병솔정상승추세。본연구지재비교고령노인화년경노인량조흉단식관린암환자림상병리자료、수술급술후정황，분석불동수술입로대고령노년환자적영향。방법：회고성분석2006년1월-2008년12월안휘의과대학부속성립의원흉외과수치적흉단식관린암노년환자(60세이상)371례。기중≥75세적고령노인53례，60~74세적년경노인318례，분별비교량조환자림상병리특정、수술정황、병발증급술후원내사망솔화평균주원시간，동시근거수술입로불동분위좌진흉입로여우진흉입로，비교수술시간、술중출혈량급술후병발증발생솔등정황。결과：고령노인조여년경노인조상비술전합병증경다，술전ASA분급경고，술후병발증、주원시간급원내사망솔균명현증고，고령노인조좌흉입로교우흉입로술후병발증특별시폐부병발증경소(13.0% vs 40.0%)，차이유통계학의의(P<0.05)。결론：≥75세적노년흉단식관린암환자수술풍험교대，가이통과선택상대간단적수술방식，감소술후병발증특별시폐부병발증적발생솔。
Background and purpose: The incidence rate of elderly esophageal carcinoma patients is increasing year by year. In this study, the clinicopathologic factors, operational factors and postoperative complications were compared between the older and the younger elderly patients with thoracic esophageal squamous cell carcinoma (ESCC), and the influence of different surgical approaches to older elderly patients were analyzed. Methods: A retrospective review of 371 cases of elderly patients with thoracic esophageal squamous cell carcinoma (≥60 years) between Jan. 2006 and Dec. 2008 were performed. The patients were divided into two age groups. The patients over 75 years old named the older elderly group including 53 patients, and the patients between 60-74 years named the younger elderly group including 318 patients, the clinicopathological factors, operational factors, postoperative hospital mortality and average length of stay were compared. Meanwhile, according to different surgical approaches, the comparison of the left chest and right chest approach of operative time, blood loss and postoperative complication rate, and so on and so forth. Results: The older elderly group compared with the younger elderly group had more preoperative complications. Preoperative ASA classiifcation and postoperative complications, length of stay and hospital mortality rates were signiifcantly higher. The older elderly group over the right chest approach had less postoperative complications, especially pulmonary complications, the results were statistically signiifcant.(13.0%vs 40.0%,P<0.05) Conclusion: The patients over 75 years old with thoracic esophageal squamous cell carcinoma have a higher risk during the operation, we can choose relatively simpler operation approach to reduce the incidence of postoperative complications, especially pulmonary complications.