良性病变全肺切除术后近期并发症危险因素分析

Risk factors of early postoperative complications after pneumonectomy for benign disease

目的探讨良性疾病全肺切除术的手术指征和术后近期并发症的影响因素。方法回顾性分析136例良性疾病全肺切除术患者的临床资料，随访术后30天内发生的并发症。采用单因素和多因素分析良性疾病全肺切除术后并发症发生的危险因素。结果33例（24．26％）出现术后并发症，围术期死亡5例（3．68％）。单因素分析显示疾病类型（P=0．041）、术侧（P=0．014）、出血量（P=0．010）及手术持续时间（P=0．009）是术后并发症的主要影响因素。多因素分析显示疾病类型（HR3．158，95％CI1．248～7．992，P=0．015）和手术持续时间（HR2．508，95％CI1．035—6．080，P=0．042）为良性病变全肺切除术后发生并发症的独立危险因素。结论良性疾病全肺切除术后伴有高并发症发生率。但通过严格掌握手术适应证和科学合理进行围术期管理可以有效降低围术期死亡率和并发症发生率。全肺切除仍然可以作为良性肺疾病治疗的选择。

Objective To investigate indications and early postoperative morbidity of patients who underwent pneumo nectomy for benign lung disease, Methanols We retrospectively analysed 136 patients with benign lung diseases undergone pneumonectomy, and collected clinical database about early postoperative complications. We used logrank test and Cox pro portional hazards methods to identify potential independent risk factors for early postoperative complications after pneumonecto my for benign disease. Results The early morbidity and mortality were 24.6%, 3.68%, respectively. Univariate analysis showed etiology（ P = 0.041 ）, anatomical side （ P 〈0. 014）, blood loss （ P = 0. 010） and duration of operation （ P = 0. 009 ） were the risk factors of early complications after pneumonectomy for benign disease. However, etiology（ HR 3. 158, 95% C1 1. 248 7. 992, P = 0. 015 ） and duration of operation （ HR 2. 508, 95 % CI 1. 035 6. 080, P = 0. 042 ） were the independent risk factors. Conclusion Pneumonectomy for benign lung disease is a highrisk procedure that is performed for a variety of in dications, but it can effectively reduce postoperative mortality and morbidity through the strict indication of operation and scien tific perioperative management. Pneumonectomy for benign disease should be considered a treatment option for carefully select ed patients.