胸腔镜肺癌根治术后肺部并发症对远期预后的影响  

The long-term impact of postoperative pulmonary complication after resection of non-small cell lung cancer

作　　者：王少东[1] 隋锡朝[1] 李晓 李运[1] 李剑锋[1] 姜冠潮[1] 刘军[1] 王俊[1] 

机构地区：[1]北京大学人民医院胸外科,100044

出　　处：《中华胸心血管外科杂志》2018年第1期1-5,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：北京市科技计划（D141100000214004）

摘　　要：目的 探索肺癌术后肺部并发症对远期预后的影响及其危险因素.方法 回顾性分析2010年1月至2014年12月北京大学人民医院采用胸腔镜肺癌根治术治疗的非小细胞肺癌患者资料,总结其术后肺部并发症情况,依据TMM标准分级,Ⅱ级以上为主要并发症,采用Kaplan-Meier法进行生存比较,探究肺部并发症对患者远期预后的影响,多因素logistic回归分析筛选主要肺部并发症的高危因素.结果 全组共574例患者,男295例,女279例;年龄（65.2±10.0）岁,106例（18.5％）出现肺部并发症,其中主要肺部并发症50例（8.7％）,术后主要肺部并发症组患者带管时间和住院天数显著延长（均P〈0.001）、围手术期死亡显著增加（4.0％对0.6％,P=0.021）.Cox多因素生存分析显示,主要肺部并发症是肺癌患者远期死亡（HR：3.17,95％CI：1.94～5.15,P〈0.001）和复发（HR：2.66,95％CI：1.76～4.01,P〈0.001）的独立预后因素.Logistic多因素回归分析显示,主要肺部并发症的独立危险因素为年龄〉70岁（HR：3.32）、男性（HR：2.12）和ASA评分.结论 主要肺部并发症是肺癌远期死亡和复发的独立危险因素,高龄、男性和ASA评分为主要肺部并发症的高危因素. Objective To determine the long-term impacts of major pulmonary complications （ MPCs） and identify the in-dependent risk factors in those non-small cell lung cancer（NSCLC）patients who underwent VATS lobectomy.Methods A ret-rospective study was developed to analyze the pulmonary complications of 574 non-small cell lung cancer patients who under-went VATS lobectomy in Peking University Hospital , the complications were graded according to TMM classification criteria . The effects of PCs on the long-term prognosis were analyzed by using the Kaplan-Meier method.Multivariate logistic regression analysis was used to determine the risk factors of MPCs.Results Of 574 patients, 106 had PCs, including 50（8.7%） MPCs, Postoperative pulmonary complications were associated with significantly longer drainage time （P〈0.001） and hospital stays（P〈0.001）.Perioperative mortality was significantly increased in patients with PCs （4.0% vs 0.6%; P =0.021）. Those who develop a MPC had a reduced 3-year DFS and 5-year DFS（61.3% vs.77.4%、42.2% vs.69.3%;P=0.003）, as well as the reduced 3-year OS and 5-year OS（78.5%vs.88.2%、62.4% vs.79.2%;P=0.047）.MPCs were independ-ent prognostic factors of patients with lung cancer .Multivariate logistic regression analysis showed that the independent risk fac-tors for MPCs were age, male, ASA grade.Conclusion Major pulmonary complications after VATS lobectomy are associated with a poorer long-time outcome.The independent risk factors for MPCs are age, male, and ASA grade.

关 键 词：肺肿瘤 胸腔镜检查 手术后并发症 

分 类 号：R734.2[医药卫生—肿瘤]