右侧非小细胞肺癌患者双肺叶切除与单肺叶切除术后并发症的比较

Postoperative Complications of Bilobectomy Compared with Lobectomy in the Right Lung of Non-small Cell Lung Cancer Patients

背景与目的双肺叶切除后剩余肺叶与胸膜腔空间不匹配是右侧非小细胞肺癌(non-small cell lung cancer,NSCLC)患者术后高并发症发病率的主要原因。本研究旨在比较右侧NSCLC双肺叶切除与单肺叶切除患者术后并发症发生率之间的差异。方法本研究共纳入行右侧肺叶切除NSCLC 528例,右肺单肺叶切除病例352例(108例上叶与244例下叶)为对照组,右肺双肺叶切除病例176例(57例中上叶与119例中下叶)为观察组。两组病例行回顾性病例-对照配对研究。两组病例按照年龄、性别、术前预计FEV1%、LEVF%、手术方式、术前心脏伴随疾病、术后管理方式、病理类型、肿瘤大小等情况进行按1:2进行配对。比较两组患者术后30天内死亡率、空间相关并发症(肺不张、漏气大于5天、气胸)发生率与心肺并发症(院内获得性肺炎、低氧气血症、肺栓塞、脑卒中、心律失常、心肌缺血或梗塞、心功能不全)发生率之间的差异。结果双肺叶切除组病例术后30天死亡率为3.4%(6/176),单肺叶切除组病例为2.3%(8/352),两者间差异无统计学意义;双肺叶切除组病例术后心肺并发症总体发病率为23.8%(42/176)高于单肺叶切除组10.7%(38/352),差异具有统计学意义;双肺叶切除组中下叶切除病例的心肺并发症发病率为26.5%(31/119)远高于单肺叶切除组4.9%(12/244);而空间相关并发症双肺叶切除组与单肺叶切除组分别为20.4%(36/176)和17.3%(61/352),两者间差异无统计学意义。结论右侧NSCLC双肺叶切除患者术后心肺相关并发症发生率高于单肺叶切除患者,30天内死亡率与空间相关并发症发生率无明显差异。

Background and objective The mismatch between pleural space and remnant lung after bilobectomy has been considered as the main reason for the high incidence of postoperative complications in non-small cell lung cancer（NSCLC） patients.The aim of this study is to analyze the differences in postoperative complications between bilobectomy and lobectomy in the right lung of NSCLC patients.Method This study included 528 NSCLC patients who underwent right pulmonary lobectomy.A total of 352 cases that underwent upper or lower right lobectomy（108 upper and 244 lower） were the control group,and 176 cases that underwent bilobectomy（57 upper and middle and 119 lower and middle） were the observation group.A retrospective case-control study was performed on a series of matched NSCLC patients.Cases and controls were matched by age,ppoFEV1%,LEVF%,operation method,cardiac comorbidity,type of postoperative management,and pathological type at a ratio of 1：2.The prevalence of 30-day death,occurrence of cardiac-respiratory complications（hospitalacquired pneumonia,low oxygen concentration,pulmonary embolism,cerebral apoplexy,arrhythmia,myocardial ischemia or infarction,and cardiac insufficiency） and occurrence of space-related complications（atelectasis,air leak more than 5 days,and pneumothorax） were compared between the bilobectomy and lobectomy groups.Result The prevalence of 30-day death was 3.4%（6/176） in the bilobectomy group and 2.3%（8/352） in the lobectomy group.No statistical significance was observed between the two groups.The cardiac-respiratory complication rate in bilobectomy group（23.8%;42/176） was higher than that in lobectomy group（10.7%;38/352）.The cardiac-respiratory complication rate of the lower and middle pulmonary lobectomypatients in the bilobectomy group（26.5%;31/119） was significantly higher than that in the lower pulmonary lobectomy patients（4.9%;12/244）.The space-related complications in bilobectomy group and lobectomy group were 20.4%（36/176） and 17.3%（61/352）,respectively.No statistically significant difference between the two groups was observed.Conclusion The postoperative cardiac-respiratory complications of NSCLC patients with right bilobectomy are higher than those of the right lobectomy patients,but the prevalence of 30-day death and space-related complication was not statistically different between the two groups.