老年肺癌的文献研究

【作者】 孙有泉；

【导师】 胡凯文；

【作者基本信息】 北京中医药大学 ， 中西医结合内科学， 2007， 硕士

【摘要】 随着社会的老年化,肺癌的发病率逐年上升,其发病率随着年龄的增长而提高,发病高峰年龄为70～74岁,且年龄越大死亡率越高。老年人由于衰老,各器官在功能调节、结构等多方面出现减退现象,使得老年人在中医病因病机、症状体征及治疗方面有着自身特点。老年人的免疫功能下降,故老年人对细菌、病毒、物理、化学等致病因素的抵抗能力下降,这就决定了老年肺癌临床特点合并症多,如呼吸系统疾病、心血管疾病和糖尿病等,有时可合并三种以上疾病。老年人全身局部反应性低,症状较隐匿,其诊断时多为晚期,全身机能减退,使得老年肺癌患者难以承受传统手术及放疗,放化疗毒副反应大。鉴于上述特点,老年肺癌就同时具有老年人和肺癌的双重特点,故治疗上老年肺癌有其自身特点。而年龄并不是影响生存率及治疗有效率的决定性因素,治疗的选择必须选择那些毒副作用可以耐受,且具有较好疗效,能使大多数老年患者受益的治疗。本文通过对国内外相关文献的研究,探讨了老年肺癌患者在中医病因病机、流行病学、诊断、手术治疗、放射治疗、化学治疗、生物治疗、微创治疗及中药治疗等多诸多方面的特点:正气虚弱是老年肺癌患者发病的主要因素,各种新的检查手段的应用于临床,提高了临床诊断率,随着科学技术的发展,新的手术术式的发展,使得老年肺癌患者部分可以接受手术治疗,新的术式对老年患者保留了肺功能,术后死亡率减低,且疗效与根治手术相仿;新的放疗技术的发展尤其三维适形放疗技术临床应用,使得放疗更加适形,剂量、疗效提高,且毒副作用减少,使得更加适合老年患者,放疗模式的更新及与手术化疗配合治疗提高了临床效果;新的毒副反应小的化疗药物和方案应用大大改善了老年肺癌治疗现状;近年来新出现的基因、免疫、靶向治疗其较之化疗有着较好的临床疗效,且毒副反应相对较低,且治疗的针对性强,成为老年肺癌患者新的可选择的治疗;微创也是目前研究的热点之一,其因创伤小,局部疗效好的特点,尤其适合那些不能承受手术、放化疗等创伤或毒副反应较大的治疗,且经微创治疗后减轻肿瘤负荷,可提高患者体力状态,从而使老年患者接其他治疗提供可能;中医药治疗的肺癌可以提高化疗效果及减轻放化疗毒副反应,加快患者的恢复,提高患者生活质量,是老年肺癌患者较好的选择。手术、化疗加之与放疗、免疫治疗、生物治疗及中医药等多种方法合理配合的综合治疗,使的老年肺癌患者的肿瘤缓解率、生存治疗提高率及生存期延长率都有了较大的提高,以及各种微创技术的应用对肺部局部肿块的消除大大提高了疗效,并且使老年患者能够承受。目前综合治疗已成为老年肺癌治疗的一种较好的治疗模式。更多还原

【Abstract】 With the aging society, incidence rate of lung cancer has increased. The incidence rate increases with growth of age. The peak age of lung cancer is 70 to 74 years of old. And the older the age the higher the mortality.As the aging of older persons, the organ of the functional regulation, and structure of various emerging subside. In this situation, the elderly have their own characteristics in etiopathogenisis and pathogenesis of traditional Chinese medicine (TCM), signs, symptoms and treatment. The elderly decreased immune function, therefore, the elderly dropped in the resistance on bacteria, viruses, physics, chemistry and other factors. This determines that elderly lung cancers have many complications, such as respiratory diseases, cardiovascular diseases and diabetes, sometimes with more than three diseases. Elderly have a low reaction in systemic and local. The symptoms become more concealed. Elderly patients are with systemic hypofunction for more advanced at the time of diagnosis. Elderly patients with lung cancer are unbearable to traditional surgery and radiotherapy, Chemoradiotherapy with large side effects.Given these characteristics, elderly lung cancer simultaneously have the dual characteristics, the elderly and of lung cancer. Therefore, the treatment of lung cancer has its own characteristics. But, age is not a significant prognostic factor for overall survival and response to treatment. Treatment options must choose which side effects can be tolerated and has better efficacy, and most elderly patients can benefit from the treatment.Based on the study of the relevant documents at home and abroad, talked about elderly lung cancer in etiopathogenisis and pathogenesis of TCM, epidemiology, diagnosis surgery, radiation therapy, chemotherapy, biological therapy, minimally invasive treatment and TCM for many aspects and other features. Upright weak is main factor to older patients with lung cancer. It improved the rate of clinical diagnosis with using the new means of inspection applications. Along with the development of science and technology, and new surgical procedures, elderly patients can receive surgical treatment. New procedure can preserve lung function for elderly patients, and its effect is similar to radical surgery. With new radiotherapy technology development, especially the three-dimensional conformal radiotherapy techniques clinical application, it makes more conformal radiotherapy, increses dose, effect, and reduces the side effects, and is more suitable for elderly patients. Using new mode of radiotherapy with surgery and chemotherapy to treatment improved the clinical results. With the low side effects of chemotherapy drugs and application used in clinical, the treatment of elderly patients with lung cancer improved greatly. In recent years, the new gene, immunization, targeting, which clinical efficacy is better than of chemotherapy, have lower side effects than chemotherapy. As it well-targeted , it is a new option for elderly patients with lung cancer. Minimally invasive current study is one of the hot spots. It is suitable for those who can not afford surgery, radiotherapy and chemotherapy, and other injuries or adverse reactions, because of the features of small trauma and good partial efficacy. Minimally invasive treatment can reduces tumor burden and increases physical state of patients, in this situation older patients can possiblely receive other treatment. Chinese medicine treatment of lung cancer can improve the efficacy of chemotherapy and reduce side effects of radiotherapy and chemotherapy, speed up the recovery of patients, and improve the quality of life of patients. It is a better choice for older patients with lung cancer.The comprehensive treatment combined with Surgery, chemotherapy, radiotherapy, immunotherapy, biological treatment and Chinese medicine, and other methods, improved tumor response rate, survival rate and long-term survival rate. And varieties of minimally invasive techniques enhance the efficacy for elimination of local pulmonary tumor, and are bearable for elderly patients. Currently, comprehensive treatment of lung cancer has become a good treatment modality for the elderly patients with lung cancer.更多还原