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目的:探讨老年乳腺癌患者的临床特点及围手术期处理策略。方法:回顾性分析自2002年2月—2011年2月接受手术治疗的2 643例乳腺癌患者的临床资料,其中年龄≥65岁者186例(老年组),<65岁者2 457例(非老年组),比较两组乳腺癌患者临床病理特征及术后并发症情况。结果:老年组术前存在合并症及有2种或2种以上合并症的患者均明显多于非老年组率(94.6%vs.68.1%;78.5%vs.40.7%,均P<0.05),发生率较高的合并症为心电图改变、高血压病和冠心病(分别占89.25%、68.38%、37.10%);两组术后总并发症发生率差异无统计学意义(P>0.05),但老年组术后出血、皮下积液、切口感染、肺部感染、心律失常、心功能不全、静脉血栓的发生率高于非老年组,患侧肩部疼痛发生率低于非老年组(均P<0.05)。两组间组织病理学差异无统计学意义(P>0.05),但老年组的临床分期高于非老年组(P<0.05)。老年乳腺癌组术后并发症的发生率为83.9%(156/186),术前合并心电图改变、高血压病、冠心病、糖尿病者术后并发症发生率较高。结论:老年乳腺癌患者有特殊的临床特点,需加强围手术期管理。
Objective: To investigate the clinical features and perioperative management strategies of elderly patients with breast cancer. Methods: The clinical data of 2 643 breast cancer patients who underwent surgery from February 2002 to February 2011 were retrospectively analyzed. There were 186 cases (aged group) ≥45 years and 2457 cases (65 cases) Non-elderly group). The clinicopathological features and postoperative complications of two groups of breast cancer patients were compared. Results: There were significantly more patients with preoperative comorbidities and 2 or more comorbidities in the elderly group than those in the non-elderly group (94.6% vs.68.1%; 78.5% vs.40.7%, all P <0.05) The higher complication rates were ECG changes, hypertension and coronary heart disease (89.25%, 68.38%, 37.10% respectively). There was no significant difference in the incidence of postoperative complications between the two groups (P> 0.05) However, the incidence of postoperative bleeding, subcutaneous effusion, incisional infection, pulmonary infection, arrhythmia, cardiac insufficiency and venous thrombosis in the elderly group was higher than that in the non-elderly group, and the incidence of shoulder pain in the affected side was lower than that in the non-elderly group P <0.05). The histopathological differences between the two groups were not statistically significant (P> 0.05), but the clinical stage of the elderly group was higher than that of the non-elderly group (P <0.05). The incidence of postoperative complications in the elderly breast cancer group was 83.9% (156/186). Preoperative combined electrocardiographic changes, hypertension, coronary heart disease and diabetes were associated with a higher incidence of postoperative complications. Conclusion: The elderly patients with breast cancer have special clinical features, need to strengthen perioperative management.