胃癌术后肺部并发症相关危险因素分析

Potential risk factors for postoperative pulmonary complications in gastric cancer patients

目的比较胃癌术后发生肺部并发症病人与无并发症病人间临床病理特征,并分析胃癌术后肺部并发症发生的危险因素。方法回顾性分析2012年1月至2015年12月四川大学华西医院胃肠外科收治的719例胃癌手术病人临床资料。排除残胃癌、术前接受化疗以及无肺部并发症但合并其他并发症病例后,分为肺部并发症组(103例)与无并发症组(616例)。结果肺部并发症组病人术后住院时间较无并发症组延长[(13.5±7.0)d vs.(10.7±3.1)d,P<0.001],其余指标组间差异无统计学意义(P>0.05)。单因素分析显示,年龄(P=0.018)、肺部疾病史(P<0.001)、术前肺功能[1 s用力呼气量与用力肺活量比值(FEV1/FVC),P=0.002]、血红蛋白(P=0.004)、术中出血(P=0.042)以及手术时间(P=0.048)与肺部并发症发生相关;多因素分析发现,肺部疾病史(P<0.001)、术前肺功能(P=0.032)以及血红蛋白(P=0.004)为影响胃癌术后肺部并发症发生的独立危险因素。结论对于BMI≥25、合并肺部基础疾病、FEV1/FVC<60、血红蛋白<90 g/L的胃癌病人,应注意采取必要措施以减少术后肺部并发症发生。

Objective To compare the clinicopathological characteristics between postoperative pulmonary complications （PPCs） patients and non-complication patients, to identify the potential risk factors for developing PPCs. Methods The clinical data of 719 gastric cancer patients who underwent gastrectomy in West China Hospital of Sichuan University from January 2012 to December 2015 were analyzed retrospectively. Patients received preoperative chemotherapy, diagnosed as remnant gastric cancer or had any other postoperative non-pulmonary complications were excluded. All the patients were divided into PPCs group （103 patients） and non-PPCs group （616 patients）. Results Patients in the PPCs groups had significantly longer postoperative hospital stay than patients in the non-PPCs group [（13.5±7.0） d vs. （10.7±3.1）d, P〈0.001]. Other data had no statistical difference between two groups （P〉0.05）. The age of patients （P=0.018）, history of pulmonary disease （P〈0.001）, preoperative pulmonary function test （FEV1/FVC） （P= 0.002） , hemoglobin level （P=0.004）, intraoperative blood loss （P=0.042） and surgical duration （P=0.048） were risk factors identified by the univariate analysis. Finally, the logistic regression found out that, history of pulmonary disease （P〈0.001）, preoperative pulmonary function test （P=0.032） and hemoglobin level （P=0.004） were the independent risk factors for the incidence of the PPCs. Conclusion The postoperative pulmonary complication is one of the common complications of the gastric cancer patients. Body Mass Index level （1〉25）, history of pulmonary disease, preoperative pulmonary function test （FEV1/FVC〈60） and hemoglobin level （〈90 g/L） were the independent risk factors for the incidence of the PPCs.