| 范晓东,陈 召,陈 静,卢 强,张继朋,王武平,李 哲.胸膜腔黏连对非小细胞肺癌患者行胸腔镜下肺叶切除术的影响分析[J].,2019,19(5):928-932 |
| 胸膜腔黏连对非小细胞肺癌患者行胸腔镜下肺叶切除术的影响分析 |
| Effect of Pleural Adhesion on the Thoracoscopic Lobectomy in Patients with Non-small Cell Lung Cancer |
| 投稿时间：2018-09-18 修订日期：2018-10-12 |
| DOI：10.13241/j.cnki.pmb.2019.05.030 |
| 中文关键词: 胸膜黏连 非小细胞肺癌 胸腔镜 肺叶切除 并发症 |
| 英文关键词: Pleural adhesion Non-small cell lung cancer Thoracoscopic Lobectomy Complications |
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| 中文摘要: |
| 摘要 目的：分析胸膜腔黏连对非小细胞肺癌患者行胸腔镜下肺叶切除术的影响，探讨患者行胸腔镜下肺叶切除术术后发生并发症的影响因素。方法：收集2014年1月到2017年12月份在我科行胸腔镜下肺叶切除的非小细胞肺癌患者，通过检索电子病历和电话随访的方式收集患者的基本资料，包括性别、年龄、BMI指数、是否吸烟、一秒用气呼气容积百分比(Percentage predicted forced expiratory volume in 1 s, FEV1 %)、美国麻醉医师协会评分(American Society of Anesthesiologists，ASA)、术后病理结果和术前合发症等资料。收集患者手术相关情况，包括胸膜是否黏连、手术时间、术中出血、术中中转开胸、术后引流、住院时间、并发症和术后30天死亡，根据患者是否有胸膜黏连将其分为两组，对比分析两组基本情况和术后情况，观察胸膜黏连对术中及术后的影响。根据术后是否发生并发症将患者分为两组，对比分析两组的指标，并对有差异的指标进行Logistic回归分析，探讨胸膜黏连是否为术后并发症的独立危险因素和其他危险因素。结果：根据纳入排除标准，共有447例患者纳入研究，其中有142例患者术中发现胸膜黏连，胸膜黏连的患者手术时间、术中出血、中转开胸、术后前两天引流量、引流时间、术后住院时间和术后并发症发生率均高于胸膜没有黏连的患者(P＜0.05)。术后发生并发症的患者年龄、女性比例、吸烟人数、术前呼吸并发症、胸膜黏连、ASA评分和手术时间均高于术后未发生并发症的患者(P＜0.05)。胸膜黏连(OR=4.185, P=0.020)、ASA评分(OR=1.143, P=0.001)、吸烟(OR=3.329, P=0.005)、手术时间延长(OR=1.623, P=0.038)和术前呼吸合并症(OR=2.713, P=0.027)均是术后发生并发症的独立危险因素。结论：胸膜黏连增加了非小细胞肺癌患者行胸腔镜下肺叶切除术的手术难度、术中中转开胸和术后并发症发生的风险。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the effect of pleural adhesion on the thoracoscopic lobectomy in patients with non-small cell lung cancer, and explore the influencing factors of postoperative complications after thoracoscopic lobectomy. Methods: Patients with non-small cell lung cancer who underwent thoracoscopic lobectomy in our department from January 2014 to December 2017 were col- lected. The basic data of patients were collected by searching electronic medical records and telephone follow-up, including gender, age, BMI index, Percentage predicted forced expiratory volume in 1 s (FEV1%), American Society of Anesthesiologists (ASA), postoperative pathological findings, and preoperative complications. The patient's surgery-related conditions were collected, including pleural adhesion, operative time, intraoperative bleeding, intraoperative conversion, postoperative drainage, length of hospital stay, complications, and 30-day postoperative death. Patients were divided into two groups according to whether they had pleural adhesion or not. The basic infor- mation and postoperative conditions of the two groups were compared and analyzed. The effects of pleural adhesion on intraoperative and postoperative results were observed. In addition, the patients were divided into two groups according to whether they had postopera- tive complications or not. The indexes of two groups were comparatively analyzed. Logistic regression analysis was performed to investi- gate the risk factors for postoperative complications. Results: According to the inclusion and exclusion criteria, a total of 447 patients were included in the study and 142 patients had pleural adhesion. The operative time, intraoperative bleeding, conversion to thoracotomy, drainage at two days after surgery, drainage time, postoperative hospital stay, and postoperative complications of patients with pleural ad- hesion were higher than those of patients without pleural adhesion (P＜0.05). The age, female proportion, smoking number, preoperative respiratory complications, pleural adhesion, ASA score, and operation time of patients with postoperative complications were higher than those without postoperative complications (P<0.05). Pleural adhesion (OR=4.185, P=0.020), ASA scores (OR=1.143, P=0.001), smoking (OR=3.329, P=0.005), extended operative time (OR=1.623, P=0.038) and preoperative respiratory complications (OR=2.713, P=0.027) were independent risk factors for the postoperative complications. Conclusion: Pleural adhesion increases the difficulty of thoracoscopic lobectomy in patients with non-small cell lung cancer, intraoperative conversion, and risk of postoperative complications. |
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