术前放化疗对食管癌患者肺功能和术后肺部并发症的影响  

Influence of preoperative chemoradiotherapy on pulmonary function and postoperative pulmonary complication in esophageal cancer patients

作　　者：胡荣贵[1] 傅剑华[1] 罗孔嘉[1] 张旭[1] 杨弘[1] 刘孟忠[2] 刘慧[2] 李群[1] 胡永红[2] 李小东[1] 林婷[1] 

机构地区：[1]华南肿瘤学国家重点实验室广东省食管癌研究所中山大学肿瘤防治中心胸外科,广州510060 [2]华南肿瘤学国家重点实验室广东省食管癌研究所中山大学肿瘤防治中心放疗科,广州510060

出　　处：《中华胃肠外科杂志》2013年第9期827-830,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：卫生部部属（管）医院临床学科重点项目（179）;广东省科技计划项目（2012A030400007）;中山大学临床医学研究5010计划（2007048）

摘　　要：目的 探讨术前放化疗对食管癌患者肺功能及术后肺部并发症的影响.方法 回顾性收集2002-2013年间中山大学肿瘤防治中心连续收治的术前同期放化疗并手术治疗的63例食管鳞癌患者放化疗前后肺功能指标及其术后肺部并发症的发生情况,分析放化疗前后肺功能的各项指标的变化及其对术后肺部并发症的影响.结果 放化疗后,63例患者一氧化碳弥散量（DLco％）较治疗前明显降低（83.7±17.7比96.4±17.8,P＜0.01）,而其他肺功能指标均未见明显变化（P＞0.05）.术后肺部并发症发生率为34.9％（22/63）,其中肺炎19例,急性肺损伤/急性呼吸窘迫综合征3例.术前肺弥散功能正常者（DLco％大于或等于80）和异常者（DLco％小于80）,术后肺部并发症发生率的差异无统计学意义[29.7％（11/37）比41.7％（10 /24）,P=0.338].放疗后DLco％明显下降者（DLco％下降大于或等于15％）和无明显下降者（DLco％下降小于15％）,术后肺部并发症发生率的差异亦无统计学意义[31.6％（6/19）比37.8％（14/37）,P=0.664].结论 术前放化疗会降低食管癌患者肺弥散功能,但并不损伤肺通气功能,亦不会增加术后肺部并发症发生率.Objective To study the influence of preoperative chemoradiotherapy （CRT） on pulmonary function and postoperative pulmonary complications in esophageal cancer patients.Methods Pulmonary function and postoperative pulmonary complications of 63 esophageal cancer patients undergoing preoperative CRT and operation in Cancer Center of Sun Yat-sen University between 2002 and 2013 were collected retrospectively.The influence of preoperative CRT on pulmonary functional indexes and postoperative pulmonary complications were analyzed.Results After preoperative CRT,DLco% decreased significantly （83.7±17.7 vs.96.4±17.8,P〈0.01）,while no obvious changes in other indexes were found.Postoperative pulmonary complication rate was 34.9%（22/63）,including 19 cases of pneumonia and 3 cases of acute pulmonary injury/acute respiratory distress syndrome.Differences in postoperative pulmonary complication rates were not statistically significant between patients with DLco% 〈80 and those with DLco% ≥80 patients （29.7% vs.41.7%,P〉0.05）,and between patients with DLco% decline ≥15% and those with DLco% decline 〈15% patients （31.6% vs.37.8%,P〉0.05）.Conclusion Preoperative CRT can damage the diffusion function but not ventilation functio n of esophageal cancer patients,and does not increase the postoperative pulmonary complication rate.

关 键 词：食管肿瘤 术前放化疗 肺功能 肺部并发症 

分 类 号：R735.1[医药卫生—肿瘤]