肺气肿对早期肺癌手术患者预后的影响  

Effect of emphysema on prognosis of patients undergoing surgery for early-stage lung cancer

作　　者：段东奎[1] 王新[1] 张春敭[2] DAUN Dongkui;WANG Xin;ZHANG Chunyang(Department of Thoracic Surgery,Nanyang Center Hospital,Henan Nanyang 473009,China;Department of Thoracic Surgery,First Affiliated Hospital to Zhengzhou University,Henan Zhengzhou 450000,China)

机构地区：[1]南阳市中心医院胸外科,河南南阳473009 [2]郑州大学第一附属医院胸外科,河南郑州450000

出　　处：《现代肿瘤医学》2022年第3期460-465,共6页Journal of Modern Oncology

基　　金：河南省医学科技攻关计划项目(编号:2018020067)。

摘　　要：目的:探讨肺气肿与早期肺癌患者肺切除术后长期预后、死亡率和术后并发症之间的关系。方法:回顾性分析2010年01月至2014年12月在我院行手术治疗的非小细胞肺癌(non-small cell lung cancer,NSCLC)患者364例。采集患者人口学、疾病特征、手术方式、手术相关并发症和随访资料。选择术前2周内拍摄的全肺CT图像,采用Pulmo图像分析软件分析低衰减区百分比(LAA%)。公式为LAA%=肺低衰减区/全肺体积×100%。LAAs>10%定义为肺气肿。结果:63例(17.3%)患者出现肺气肿。无肺气肿组和肺气肿组的5年总生存率分别为89.0%和61.3%(P<0.001),5年无复发生存率分别为81.0%和51.7%(P<0.001)。多因素Cox回归分析发现,肺气肿的存在、吸烟指数较高、组织学分级较高是总生存率差的独立预测因子(P<0.05);而肺气肿的存在、吸烟指数较高、用力肺活量占预计值的百分比[FVC(%)]降低、组织学级别高和胸膜浸润是无复发生存率差的独立预测因子(P<0.05)。术后Clavien-Dindo系统分级≥Ⅱ级的心肺并发症中,肺气肿组发生需要抗生素治疗的肺炎(P=0.001)和需要药物治疗的室上性心动过速(P=0.026)高于无肺气肿组。结论:肺气肿的存在影响早期肺癌患者的远期预后和术后并发症的发生。建议术前应使用CT对肺癌患者的肺气肿情况进行评估。Objective:To investigate the relationship between emphysema and long-term prognosis,mortality and postoperative complications in patients with early lung cancer after pneumonectomy.Methods:364 patients with NSCLC admitted to our Hospital from January 2010 to December 2014 were retrospectively analyzed.The demography,disease characteristics,operation methods,operation related complications and follow-up data were collected.The whole lung CT images taken within 2 weeks before operation were selected,and the percentage of low attenuation area(LAA%)was analyzed by pulmo image analysis software.The formula was LAA%=lung low attenuation area/whole lung volume×100%.LAAs>10%was defined as emphysema.Results:63 patients(17.3%)had emphysema.The 5-year overall survival rates of non-emphysema group and emphysema group were 89.0%and 61.3%(P<0.001),respectively.The 5-year recurrence free survival rates were 81.0%and 51.7%(P<0.001),respectively.Multivariate Cox regression analysis showed that the presence of emphysema,higher smoking index and higher histological grade were independent predictors of poor overall survival rate(P<0.05),while the presence of emphysema,higher smoking index,lower FVC%,higher histological grade and pleural infiltration were independent predictors of poor recurrence rate(P<0.05).The incidence of pneumonia requiring antibiotic treatment(P=0.001)and supraventricular tachycardia requiring drug treatment(P=0.026)in emphysema group were higher than those in non-emphysema group in postoperative Clavien-Dindo system classification≥Ⅱ.Conclusion:Emphysema affects the long-term prognosis and postoperative complications of patients with early lung cancer.It is recommended that preoperative CT scan be used to evaluate emphysema in patients with lung cancer.

关 键 词：肺气肿 肺癌 预后 术后并发症 

分 类 号：R734.2[医药卫生—肿瘤]