胸腔镜亚肺叶手术后持续性漏气的原因分析  

Analysis of risk factors for prolonged air leakage after video-assisted sub-lobar resection

作　　者：程亮[1] 邹浩生[1] 于裕[1] 施义[1] 虞林湘[1] 章斌 CHENG Liang;ZOU Hao-sheng;YU Yu;SHI Yi;YU Lin-xiang;ZHANG Bin(Department of Thoracic Surgery,Jiangsu Province Hospital of Chinese Medicine,Nanjing,Jiangsu 210029,China)

机构地区：[1]江苏省中医院/南京中医药大学附属医院心胸外科,江苏南京210029

出　　处：《临床肺科杂志》2023年第2期221-224,共4页Journal of Clinical Pulmonary Medicine

基　　金：江苏省“六大人才高峰”项目(No.2016-WSW-015)。

摘　　要：目的回顾性分析胸腔镜辅助亚肺叶手术后发生持续性肺漏气的检出率,并分析其相关的危险因素。方法回顾性收集2018年1月至2020年12月在江苏省中医院胸外科接受胸腔镜辅助下亚肺叶手术患者675例。接受肺楔形手术203例,解剖性肺段切除术472例。分析临床病理因素和术后发生持续性肺漏气之间的相关性。结果术后一共出现54例(8%)患者发生肺持续性漏气。经过组间比较及多因素Logistic回归分析,显示合并胸腔粘连(OR=1.23,95%CI:0.97~1.56)、低第一秒用力呼气容积占预计值百分比(OR=1.61,95%CI:1.39~1.86)、低肺一氧化碳弥散量(OR=1.63,95%CI:1.39~1.91)以及低体重指数(OR=0.73,95%CI:0.57~0.93)是术后出现持续性漏气的危险因素。结论肺持续性漏气也是胸腔镜亚肺叶手术后常见的并发症,有危险因素的患者围术期应注意防治。Objective To analyze the risk factors for prolonged air leakage after video-assisted sub-lobar resection.Methods From January 2018 to December 2020,675 cases of video-assisted sub-lobar resection were retrospectively analyzed,including 258 males and 417 females.Prolonged air leakage was defined as lasting longer than 5 days.Patient and operative characteristics were compared using Mann-Whitney U test and chi-square tests.Significant variables on univariate analysis were entered into a multivariate Logistic regression to establish a simple predictive model to estimate the risk of prolonged air leakage.Results 472 cases received anatomical segmentectomy and 203 cases undertaken wedge resection.Of the 675 patients,8%(54/675)experienced a prolonged air leak postoperatively,associated with significantly longer hospital stay.It found that the variables such as:gender,age,smoking history,diabetes mellitus history,and surgical approaches were not significantly related with prolonged air leakage.However,univariate analysis showed that low BMI(OR=0.73,95%CI:0.57~0.93),pulmonary function[FEV_(1)%pred(OR=1.61,95%CI:1.39~1.86)and carbon monoxide diffusing capacity(OR=1.63,95%CI:1.39~1.91)]and pleural adhesion(OR=1.23,95%CI:0.97~1.56)were significantly associated with prolonged air leakage.Furthermore,the outcomes of multivariate analysis confirmed that low BMI,low pulmonary function(forced expiratory volume in 1 second and carbon monoxide diffusing capacity)and pleural adhesion were risk factors for video-assisted sub-lobar resection.Conclusion The incidence of prolonged air leakage is a common complication after video-assisted sub-lobar resection,and those with risk factors during perioperative period should be paid more attention for prevention and treatment.

关 键 词：肺部肿瘤 肺段切除术 楔形切除术 并发症 危险因素 

分 类 号：R734.2[医药卫生—肿瘤]