合并肺切除史肺癌患者再次手术的安全性和最佳手术方式分析  

Safety and optimal pattern of second surgery for lung cancer patients with history of lung resection

作　　者：林钢[1] 刘冰[1] 刘海波[1] 李简[1] 

机构地区：[1]北京大学第一医院胸外科,北京100034

出　　处：《中国胸心血管外科临床杂志》2017年第8期611-616,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨合并肺切除史肺癌患者二次手术的安全性和最佳手术方式。方法回顾性分析2007年1月至2016年6月我院69例合并肺切除史肺癌患者的临床资料,其中男53例,女16例,年龄68(45~80)岁。通过单因素方差分析和logistic多因素回归分析,分析患者围术期各指标对术后并发症的影响;通过比较肺叶切除和亚肺叶切除患者的临床数据,确定最佳手术方式。结果二次手术术后90 d死亡率为4.3%,并发症发生率为24.6%。单因素方差分析显示二次手术术后严重并发症发生与术中出血量(P=0.020)、肿瘤大小(P=0.007)、吸烟史(P=0.028)和第一秒用力呼气容积占预计值百分比(FEV1%pre,P=0.018)有关。Logistic多因素回归分析结果显示FEV1%pre<77.0%(OR=0.935,95%CI 0.888~0.984,P=0.010)和肿瘤直径≥2 cm(OR=4.288,95%CI 1.375~13.373,P=0.012)是严重并发症发生的独立危险因素。肺叶切除和亚肺叶切除术后死亡率和并发症发生率差异均无统计学意义(P=0.063)。结论合并肺切除史的肺癌患者经过筛选后进行外科手术的术后并发症和死亡率较低,是安全的。在患者心肺功能允许的情况下,二次手术首选肺叶切除+淋巴清扫,应避免全肺切除。Objective To analyze the safety of surgical treatment and optimal surgical procedure for lung cancer patients with prior history of lung resection. Methods The medical records of 69 lung cancer patients with history of lung resection was retrospectively collected. There were 53 males and 16 females with a median age of 68 years ranging from 45 to 80 years. The risk factors for postoperative complications were analyzed using one-way ANOVA and logistic regression analysis. By comparing the data between the lobectomy and sublobectomy groups, the best surgical procedure was chosen. Results The 90-day mortality rate was 4.3%. Postoperative complication rate was 24.6%. Results of one-way ANOVA showed that blood loss during operation （P=0.020）, tumor size （P=0.007）, smoking （P=0.028） and FEV1%pre （P=0.018） were associated with increased major postoperative complications. Logistic regression analysis showed that FEV1%pre〈77.0% （OR=0.935, 95%CI 0.888 to 0.984, P=0.010） and tumor size≥2 cm （OR=4.288, 95%CI 1.375 to 13.373, P=0.012） were independent risk factors for major postoperative complications. Lobectomy and sublobectomy groups had similar postoperative mortality and complication rate （P=0.063）. Conclusion Surgical resection for selected lung cancer patients with history of lung resection is safe with low postoperative mortality and complication rate. Lobectomy with lymph node resection is the first choice if cardiopulmonary function permits. Pneumonectomy is not recommended.

关 键 词：肺癌 术后并发症 肺叶切除 亚肺叶切除 

分 类 号：R734.2[医药卫生—肿瘤]