胸外科兩種手術方式對老年患者術后心肺并發癥分析

摘 要 目的:比較65歲以上老年患者行電視胸腔鏡手術(VATS)和傳統開胸手術后心、肺并發癥的發生情況。方法:將776例行胸外科手術的高齡患者根據手術方式不同分為VATS組和傳統開胸組。VATS組140例，平均年齡75.2歲;傳統開胸組636例，平均年齡73.1歲，(P>0.05)。結果:VATS組手術后心肺并發癥總發生率18.6%，傳統開胸組31.5%(P<0.05)。VATS組術后肺部并發癥發生率61.5%，傳統開胸組68.0%(P>0.05)。術后兩組心臟并發癥總發生率47.8%，肺并發癥總發生率67.3%(P<0.01)。結論:因胸部疾患行胸外科手術的高齡患者，VATS組術后心肺并發癥的總發生率明顯低于傳統開胸組。全組術后肺部并發癥發生率明顯高于心臟并發癥。因此，為了手術安全，對高齡患者應提倡采用創傷小的VATS，以減少術后心肺并發癥的發生。

關鍵詞 老年電視胸腔鏡手術 傳統開胸手術 心肺并發癥

doi:10.3969/j.issn.1007-614x.2010.24.046

AbstractObjective:To compare and analyse the postoperative cardiovascular complications and the lung complications in the elder patients over 65 years old who underwent the video assisted thoracic surgery(VATS)and the traditional thoracotomy.Methods:776 elder patients were divided into two groups:140 patients in the VATS group，the mean age was 75.2±2.5，the others in the traditional thoracotomy group，636 cases，the mean age was 73.1±2.9(P<0.05).Results:Post-operative cardio-pulmonary complications of VATS group overall incidence of 18.6%，traditional open-chest group 31.5%(P<0.05).VATS group the incidence of postoperative pulmonary complications，61.5%，68.0% of traditional open-chest group(P>0.05).Postoperative cardiac complications in the two groups overall incidence 47.8%，lung 67.3% overall incidence of complications(P<0.01).Conclusion:The morbidity of the postoperative complications in the elder patients who underwent VATS was obviously lower than that in the patients who underwent the traditional thoracotomy.So VATS is a safer operation for the elder patients.

Key Words Elder patient VATS;Traditional thoracotomy cardiovascular complication;Lung complication

為比較65歲以上患者行電視胸腔鏡手術(VATS)和傳統開胸手術后心、肺并發癥的發生情況，我們對2000年1月～2009年12月在我科行電視胸腔鏡手術(VATS)和傳統開胸手術的65歲以上患者術后出現心、肺并發癥的情況進行分析比較，現報告如下。