右胸通路胸腔镜辅助食管癌根治术后肺部感染的回顾性研究  

Retrospective Study on Pulmonary Infection after Thoracoscopic Assisted Radical Resection of Esophageal Cancer through Right Thoracic Pathway

作　　者：夏文强 扎西才让 李宁 李浩 陈和忠 XIA Wenqiang;Zhaxi Cairang;LI Ning;LI Hao;CHEN Hezhong(Department of Thoracic Surgery,The First Affiliated Hospital of Naval Medical University,Shanghai,China,200433;Department of Thoracic Surgery,Naval Medical Center,Naval Medical University,Shanghai,China,200052)

机构地区：[1]海军军医大学第一附属医院胸外科,上海200433 [2]海军军医大学海军特色医学中心胸外科,上海200052

出　　处：《食管疾病》2025年第1期48-52,共5页Journal of Esophageal Diseases

摘　　要：目的探讨右胸通路胸腔镜辅助食管癌根治术后肺部感染的危险因素。方法收集整理2023年2月至2024年4月在海军军医大学第一附属医院胸外科接受右胸通路胸腔镜辅助食管癌根治术的患者的临床资料,按术后是否发生肺部感染将患者分为感染组和非感染组。通过单因素和多因素回归分析,筛选术后肺部感染的危险因素,并进一步分析病理机制。结果本研究共纳入86例食管癌患者,其中18例发生术后肺部感染。单因素回归分析显示,年龄≥60岁、异常BMI、年吸烟≥600支、有肺部基础疾病、糖尿病、手术时间≥4 h及术前血清白蛋白<40 g·L-1,均与术后肺部感染显著相关(P<0.05)。多因素回归分析进一步表明,手术时间、有肺部基础疾病和糖尿病为术后肺部感染的独立危险因素(P<0.05)。结论手术时间延长、有肺部基础疾病或糖尿病的患者在右胸通路胸腔镜辅助食管癌根治术后发生肺部感染的风险显著增加。有针对性的预防措施有助于降低术后肺部感染的发生率。Objective To identify the risk factors associated with pulmonary infections following thoracoscopic-assisted radical esophagectomy via the right thoracic approach.Methods Clinical data were collected from patients who underwent thoracoscopic-assisted radical esophagectomy using a right thoracic approach in our hospital,between February 2023 and April 2024 and were categorized into two groups based on the presence or absence of postoperative pulmonary infections.Methods Univariate and multivariate regression analyses were employed to identify potential risk factors for postoperative pulmonary infections,and the underlying pathological mechanisms were explored.Results A total of 86 patients with esophageal cancer were included,of whom 18(20.9%)developed postoperative pulmonary infections.Univariate regression analysis indicated that age≥60 years,abnormal body mass index(BMI),a history of smoking≥600 cigarettes annually,pre-existing lung disease,diabetes mellitus,operative time≥4 h,and preoperative serum albumin levels<40 g·L-1 were significantly associated with an increased risk of postoperative pulmonary infections(P<0.05),and that prolonged operative time,pre-existing lung disease,and diabetes mellitus were independent risk factors for postoperative pulmonary infections(P<0.05).Conclusion The risk of lung infection in patients with prolonged operation time,basic lung diseases and diabetes after right thoracic approach thoracoscopic assisted radical esophagectomy for esophageal cancer is significantly increased.Targeted preventive measures can help reduce the incidence of postoperative pulmonary infections.

关 键 词：食管癌 肺部感染 危险因素 胸腔镜手术 

分 类 号：R563.1[医药卫生—呼吸系统]