COVID-19康复期患者行肺切除手术的安全性评价  

Evaluation of perioperative safety of lung surgery for patients with COVID-19

作　　者：田文鑫[1] 孙耀光[1] 吴青峻[1] 马超[1] 焦鹏[1] 于瀚博 黄川 李东航 田毅 佟宏峰[1] TIAN Wenxin;SUN Yaoguang;WU Qingjun;MA Chao;JIAO Peng;YU Hanbo;HUANG Chuan;LI Donghang;TIAN Yi;TONG Hongfeng(Department of Thoracic Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing,100730,P.R.China)

机构地区：[1]北京医院胸外科国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中国胸心血管外科临床杂志》2024年第12期1753-1758,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的评估新型冠状病毒肺炎(COVID-19)康复期患者行肺切除手术的围手术期安全性。方法回顾性分析2022年12月—2023年2月于北京医院胸外科COVID-19康复期患者行肺切除手术的临床资料,并选择同时期无COVID-19行肺切除手术患者作为对照组,比较两组患者围手术期指标。结果最终纳入103例COVID-19康复期患者,其中男44例、女59例、平均年龄(62.2±12.1)岁。所有患者均在单操作孔胸腔镜下完成手术,其中肺叶切除53例(51.5%)、肺段切除30例(29.1%)、肺楔形切除20例(19.4%)。患者确诊COVID-19距离手术间隔时间≤1个月32例(31.1%),>1个月71例(68.9%)。所有患者术前核酸检测结果均为阴性,13例(12.6%)患者术前新型冠状病毒IgM抗体为阳性,100例(97.1%)患者IgG抗体为阳性。共20例患者出现围手术期并发症:肺漏气13例(12.6%)、乳糜胸3例、心房颤动2例、严重肺部并发症2例,其中1例死亡。将上述患者与同时期无COVID-19史的肺切除手术患者比较,在手术时间、术后引流量、术后引流管留置时间、术后住院时间等方面差异无统计学意义(P>0.05),两组并发症发生情况差异亦无统计学意义(P>0.05)。对COVID-19组患者围手术期并发症发生的危险因素进行多因素回归分析显示,术前IgM抗体阳性[OR=7.319,95%CI(1.669,32.103),P=0.008]以及手术时间[OR=1.016,95%CI(1.003,1.028),P=0.013]是围手术期并发症发生的独立危险因素。结论COVID-19患者在症状消退及核酸转阴后行肺切除手术并未增加围手术期并发症发生率,不过术前COVID-19病毒特异性IgM抗体阳性是COVID-19后肺切除手术围手术期并发症发生的独立危险因素。Objective To evaluate the perioperative safety of lung surgery for patients with corona virus disease 2019(COVID-19).Methods We retrospectively analyzed the clinical data of the patients recovered from COVID-19 infection and received lung surgery from December 2022 to February 2023 in the Department of Thoracic Surgery at Beijing Hospital.Patients who received lung surgery and without COVID-19 at the same time were selected as a control group.Perioperative data between the two groups were compared.Results A total of 103 patients were included with 44 males and 49 females at an average age of(62.2±12.1)years.All surgeries were performed by uniportal video-assisted thoracoscopic surgery(VATS).Among patients who recovered from COVID-19,53(51.5%)received lobectomy,30(29.1%)received segmentectomy,and 20(19.4%)received wedge resection.The interval between diagnosis of infection and lung surgery was≤1 month in 32(31.1%)patients,and>1 month in 71(68.9%)patients.The results of virus nucleic acid test for all patients before surgery were negative.A total of 13(12.6%)patients had positive IgM,and 100(97.1%)patients had positive IgG.A total of 20 patients experienced perioperative complications(13 patients with pulmonary air leakage,3 patients with chylothorax,2 patients with atrial fibrillation,and 2 patients with severe pulmonary complications).There was one perioperative death.Comparing the patients who recovered from COVID-19 with those without COVID-19,we found no statistical difference in perioperative outcomes including surgical duration,postoperative drainage,duration of thoracic tube,and duration of postoperative stay(P>0.05).There was no significant difference in perioperative complications between the two groups(P>0.05).Multivariable logistical regression analysis demonstrated that positive IgM before surgery(OR=7.319,95%CI 1.669 to 32.103,P=0.008),and longer duration of surgery(OR=1.016,95%CI 1.003 to 1.028,P=0.013)were independent risk factors of perioperative complications for patients who recovered from COV

关 键 词：新型冠状病毒肺炎(COVID-19) 肺切除手术 围手术期并发症 危险因素 

分 类 号：R655.3[医药卫生—外科学]