肺癌术后并发症Clavien-Dindo分级≥Ⅱ级危险因素分析的多中心前瞻性队列研究  

Risk factors for postoperative complications Clavien-Dindo classification≥gradeⅡafter lung cancer surgery

作　　者：廖小清[1] 陈章[1] 戴维[2] 魏星 蒲杨 林超 冯文红 张远强[5] 牟云飞[6] 张瑞[7] 谢少华 王鑫 石丘玲 李强[2] LIAO Xiaoqing;CHEN Zhang;DAI Wei;WEI Xing;PU Yang;LIN Chao;FENG Wenhong;ZHANG Yuanqiang;MU Yunfei;ZHANG Rui;XIE Shaohua;WANG Xin;SHI Qiuling;LI Qiang(Department of Cardiothoracic Surgery,Dazhu County People's Hospital,Dazhou,635100,Sichuan,P.R.China;Department of Thoracic Surgery,Sichuan Cancer Hospital,Chengdu,610041,P.R.China;School of Public Health and Management,Chongqing Medical University,Chongqing,400016,P.R.China;Department of Thoracic and Cardiovascular Surgery,Jiangyou People's Hospital,621700,Sichuan,P.R.China;Department of Cardiothoracic Surgery,Zigong First People's Hospital,Zigong,643000,Sichuan,P.R.China;Department of Thoracic Surgery,The Third People's Hospital of Chengdu,Chengdu,610031,P.R.China;Department of Thoracic Surgery,The Seventh People's Hospital of Chengdu,Chengdu,610021,P.R.China;Center for Cancer Prevention Research,Sichuan Cancer Hospital,Chengdu,610041,P.R.China)

机构地区：[1]大竹县人民医院胸心外科,四川达州635100 [2]四川省肿瘤医院胸外科,成都610041 [3]重庆医科大学公共卫生与管理学院,重庆400016 [4]江油市人民医院胸心血管外科,四川江油621700 [5]自贡市第一人民医院胸心外科,四川自贡643000 [6]成都市第三人民医院胸外科,成都610031 [7]成都市第七人民医院胸外科,成都610021 [8]四川省肿瘤医院肿瘤预防研究中心,成都610041

出　　处：《中国胸心血管外科临床杂志》2023年第8期1151-1157,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：达州市医学研究项目(2018020)。

摘　　要：目的分析肺癌术后并发症Clavien-Dindo分级≥Ⅱ级的危险因素。方法纳入2017年11月—2020年1月多中心肺癌手术患者,分析其术后并发症的Clavien-Dindo分级,并采用logistic回归分析确定≥Ⅱ级并发症的危险因素。结果共纳入388例患者,其中男203例、女185例,平均年龄(56.14±10.36)岁。肺癌术后并发症发生率为25.52%(99/388),≥Ⅱ级并发症的发生率为20.10%(78/388)。术后最常见的5个并发症分别为:肺炎(6.96%)、持续性肺漏气(>7 d,5.67%)、切口裂开(4.64%)、心律失常(3.87%)和手术后胸腔积液(3.35%)。多因素分析结果显示:开放手术[参照为单孔胸腔镜,OR=2.18,95%CI(1.01,4.70),P=0.047]、扩大切除[参照为亚肺叶切除,OR=2.86,95%CI(1.11,7.19),P=0.030;参照为肺叶切除,OR=2.20,95%CI(1.10,4.40),P=0.026]和手术时间≥3 h[OR=2.07,95%CI(1.12,3.85),P=0.021]是肺癌术后并发症≥Ⅱ级的独立危险因素。结论手术入路、手术切除范围和手术时间是肺癌术后并发症≥Ⅱ级的独立影响因素。Objective To investigate the risk factors for postoperative complications Clavien-Dindo classification≥gradeⅡafter lung cancer surgery.Methods The patients who underwent lung cancer surgery in a multicenter observational study from November 2017 to January 2020 were included.The Clavien-Dindo classification of postoperative complications was analyzed.Logistic regression was used to identify the risk factors for complications≥gradeⅡ.Results A total of 388 patients were enrolled,including 203 males and 185 females with a mean age of56.14±10.36 years.The incidence of postoperative complications was 25.52%(99/388)after lung cancer surgery and the incidence of complications≥gradeⅡwas 20.10%(78/388).The five most common postoperative complications were pneumonia(6.96%),prolonged pulmonary air leak(>7 days,5.67%),incision dehiscence(4.64%),arrhythmia(3.87%),and postoperative pleural effusion(3.35%).Multivariate analysis showed that open surgery[reference:uniportal thoracoscopic surgery,OR=2.18,95%CI(1.01,4.70),P=0.047],extended resection[reference:sublobar resection,OR=2.86,95%CI(1.11,7.19),P=0.030;reference:lobectomy,OR=2.20,95%CI(1.10,4.40),P=0.026]and operative time≥3 h[OR=2.07,95%CI(1.12,3.85),P=0.021]were independent risk factors for postoperative complications≥gradeⅡafter lung cancer surgery.Conclusion Surgical approach,extent of resection and operative time are independent influencing factors for postoperative complications≥gradeⅡafter lung cancer surgery.

关 键 词：肺癌 手术 并发症 Clavien-Dindo分级 危险因素 

分 类 号：R734.2[医药卫生—肿瘤]