CAJ | 학술논문

目的：探讨不同手术方式（肺楔形切除和肺叶切除）对70岁以上Ⅰ期非小细胞肺癌患者预后的影响。方法：回顾性分析于2000年1月至2006年1月230例接受手术治疗的70岁以上Ⅰ期非小细胞肺癌患者的临床资料，对其预后和影响预后的临床因素进行分析。结果：单因素分析结果显示，吸烟史、T分期、手术方式、淋巴结清扫是患者预后的影响因素（P<0.05）。多因素分析提示，手术方式、T分期、淋巴结清扫均是影响70岁以上Ⅰ期NSCLC患者预后的独立因素（P<0.05）。肺楔形切除组5年生存率42.2%（35/83），肺叶切除组5年生存率50.3%（74/147），组间差异有统计学意义（P<0.05）。进一步分层分析T1a的Ⅰ期非小细胞肺癌患者，行肺楔形切除和肺叶切除的5年生存率差异无统计学意义（51.9%vs.53.3%，P>0.05）。与肺叶切除组相比，肺楔形切除组手术时间短（P=0.035）、术中失血少（P=0.031）、术后住院时间短（P=0.045）。结论：肺叶切除+系统性淋巴结清扫术仍是70岁以上Ⅰ期非小细胞肺癌患者首选的手术方式；T1a期患者行肺楔形切除可获得与肺叶切除相近的远期收益，同时肺组织损失较小，对肺功能差的高龄T1a期患者推荐行肺楔形切除术。
목적：탐토불동수술방식（폐설형절제화폐협절제）대70세이상Ⅰ기비소세포폐암환자예후적영향。방법：회고성분석우2000년1월지2006년1월230례접수수술치료적70세이상Ⅰ기비소세포폐암환자적림상자료，대기예후화영향예후적림상인소진행분석。결과：단인소분석결과현시，흡연사、T분기、수술방식、림파결청소시환자예후적영향인소（P<0.05）。다인소분석제시，수술방식、T분기、림파결청소균시영향70세이상Ⅰ기NSCLC환자예후적독립인소（P<0.05）。폐설형절제조5년생존솔42.2%（35/83），폐협절제조5년생존솔50.3%（74/147），조간차이유통계학의의（P<0.05）。진일보분층분석T1a적Ⅰ기비소세포폐암환자，행폐설형절제화폐협절제적5년생존솔차이무통계학의의（51.9%vs.53.3%，P>0.05）。여폐협절제조상비，폐설형절제조수술시간단（P=0.035）、술중실혈소（P=0.031）、술후주원시간단（P=0.045）。결론：폐협절제+계통성림파결청소술잉시70세이상Ⅰ기비소세포폐암환자수선적수술방식；T1a기환자행폐설형절제가획득여폐협절제상근적원기수익，동시폐조직손실교소，대폐공능차적고령T1a기환자추천행폐설형절제술。
Objective:To explore the prognostic influence of wedge resection and lobectomy in non-small cell lung cancer pa-tients over 70 years old. Methods:A retrospective analysis was conducted in 230 stage-I non-small cell lung cancer (NSCLC) patients (>70 years old) who underwent surgery between January 2000 and January 2006. Survival and clinical characteristics of these patients were analyzed. Results:Results of univariate analysis indicated that smoking history, T grading, surgical procedure, and lymphadenec-tomy were the factors that affected patient prognosis (P<0.05). Multivariate analysis showed that surgical procedure, T grading, and lymphadenectomy were independent prognostic factors of stage-I NSCLC patients over 70 years old (P<0.05). The 5-year survival rates were 42.2%and 50.3%in wedge resection and lobectomy cases, respectively, with statistically significant difference between the two (P<0.05). Further stratified analysis of stage-I patients with T1a indicated that no statistical significance existed in the 5-year overall sur-vival rate between the wedge resection and lobectomy groups (51.9%and 53.3%respectively, P>0.05). Compared with lobectomy, pa-tients who underwent wedge resection had shorter operative time (P=0.035), less postoperative bleeding (P=0.031), and shorter postop-erative hospital stay (P=0.045). Conclusion:Lobectomy, followed by systematic lymphadenectomy, was still the preferred surgical pro-cedure for NSCLC patients over 70 years old. However, for patients with T1a, wedge resection may have comparable long-term surviv-al benefit with lobectomy. However, wedge resection results in less damage of the lung tissues. For elderly patients with poor lung func-tion, wedge resection can be the preferred choice.