胸腔镜肺癌根治术术后并发症相关因素研究

Related factors of postoperative complications after thoracoscopic lung resection

目的探讨胸腔镜肺癌根治术术后并发症的相关因素。方法选择784例病理诊断为肺癌且行胸腔镜下肺叶切除(VATS)、系统淋巴结清扫术的患者为研究对象。根据术后并发症的发生情况分为2组,A组158例为发生术后并发症患者,B组626例为未发生术后并发症患者。对2组患者临床资料、术中及术后情况进行比较,并对具有统计学意义的结果进行多因素回归分析。结果 2组患者性别、肿瘤淋巴结转移分期及病理类型比较差异无统计学意义(P>0.05)。A组患者平均年龄大于B组,术前并发症所占比例较B组明显增多,且术前第1秒用力呼气量低于B组患者,差异均有统计学意义(P<0.05)。A组患者手术时间、术中出血量及术后住院时间均大于B组,差异有统计学意义(P<0.05);2组患者术中淋巴结清扫组数比较差异无统计学意义(P>0.05)。医师行VATS手术≥50例组的手术时间、术中出血量、术后住院时间及术后并发症发生率均低于行VATS手术<50例组,差异均有统计学意义(P<0.05);2组淋巴结清扫组数方面比较差异无统计学意义(P>0.05)。患者高龄、术前有并发症、手术时间较长、术中出血量多、术后住院时间长及医师手术经验均为术后并发症发生的危险因素(P<0.05)。结论年龄、术前并发症、手术出血量、手术时间、术后住院时间及手术者经验是胸腔镜肺癌根治术术后并发症的影响因素。

Objective To investigate the related factors of postoperative complications after thoracoscopic lung resection.Methods Seven hundred and eighty-four patients who were diagnosed as lung cancer and experienced video-assisted thoracic surgery（VATS） and the system lymph node dissection were selected.All patients were divided into group A（n = 158）which with postoperative complications and group B（n = 626） which without postoperative complications according to the postoperative complications.The clinical data,intraoperative and postoperative conditions of the two groups were compared.The results with statistical significance were selected for multivariate regression analysis.Results There was no statistic difference of gender,tumor lymph node metastasis stage and histological type between the two groups（P〉 0.05）.The average age of patients in group A was significantly greater than that in group B; the proportion of preoperative complication in group A was significantly more than that in group B; and the forced expiratory volume in 1 second in group A was lower than that in group B（P〈 0.05）.The operative time,blood loss and postoperative hospital stay in group A were significantly higher than those in group B（P〈 0.01）.There was no statistic difference of the number of lymph node dissection（P〈 0.05）.The operative time,blood loss,postoperative hospital stay and incidence of postoperative complication in operator proceeded VATS ≥50 patients group were significantly lower than those in operator proceeded VATS 50 patients group（P〈 0.05）; there was no statistic difference of the number of lymph node dissection between the two groups（P〉 0.05）.The logistic regression analysis showed that higher age,presence of complications before operation,longer operative time,larger blood loss,prolonged hospitalization and the lack of surgical experience of the surgeon were risk factors of postoperative complications（P〈 0.05）.Conclusion Age,preoperative complication,intraoperative blood loss,operative time,postoperative hospital stay and surgical experience are the related factors of postoperative complications of thoracoscopic lung resection.