食管癌术后肺部并发症的危险因素分析859例  

Risk factors for pulmonary complications in patients with esophageal cancer after esophagectomy: Analysis of 859 cases

作　　者：黄明芳[1] 刘德森[1] 潘琪[1] 陈远岷 黄重庆[1] 

机构地区：[1]广西医科大学附属肿瘤医院胸外科,广西壮族自治区南宁市530021

出　　处：《世界华人消化杂志》2014年第12期1703-1708,共6页World Chinese Journal of Digestology

摘　　要：目的:探讨食管癌患者手术后肺部并发症(postoperative pulmonary complication,POPC)的危险因素,为个体化防治POPC提供依据.方法:对1986-06/2012-06于我院行食管癌手术的859例患者资料进行回顾性分析,统计食管癌术后各种肺部并发症的发生情况,对所有可能的因素纳入研究.采用Logistic多元回归的统计学方法分析食管癌切除术后POPC发生的独立危险因素.结果:共有144例患者发生肺部并发症(占16.76%),最常见的POPC为肺炎(9.90%)、胸腔积液(5.47%)和呼吸衰竭(2.10%).分析显示:食管癌POPC与年龄、长期大量吸烟、糖尿病、肺结核病史、美国麻醉师协会(American Society of Anesthesiologists,ASA)分级、单肺通气、术后其他并发症及FEV1%pred有关(P<0.05).结论:年龄、长期大量吸烟、糖尿病、肺结核病史、ASA分级、单肺通气、术后其他并发症、FEV1%pred等都是食管癌患者POPC的独立危险因素.对具有独立危险因素,特别是同时具有多个独立危险因素的高危患者应加强围手术期个体化干预;注重完善患者术前准备,改善各器官功能状况;指导患者进行合理有效的肺功能锻炼,以降低肺部并发症的发生.AIM： To investigate possible risk factors for postoperative pulmonary complications （POPCs） in patients after esophageal cancer resection to provide a basis for individualized prevention and treatment of POPCs. METHODS： We retrospectively analyzed the data for 859 patients who underwent esophagectomy for esophageal cancer from June 1986 to June 2012 at our hospital, and observed the rate of POPCs. All possible factors influencing the occurrence of POPCs were included in our research. Independent risk factors for POPCs were evaluated by multiple logistic regression analysis.RESULTS： A total of 144 patients had POPCs, the majority of which were nosocomial pneumonia （9.90%）, pleural effusion （5.47%） and respiratory failure （2.10%）. The results of logistic regression analysis showed that POPCs were associated with age, long-term heavy smoking, diabetes, history of tuberculosis, American Society of Anesthesiology （ASA） score, one lung ventilation, other complications after surgery, and FEVl%pred （P 〈 0.05 for all）. CONCLUSION： Age, long-term heavy smoking, diabetes, history of tuberculosis, ASA score, one lung ventilation, other complications after surgery, and FEVl%pred are independent risk factors for POPCs. In order to decrease the incidence of POPCs, high-risk patients having independent risk factors, especially those having multiple independent risk factors, should receive individualized perioperative intervention.

关 键 词：食管癌 外科治疗 肺部并发症 危险因素 

分 类 号：R735.1[医药卫生—肿瘤]