肺癌合并肺纤维化患者在肺癌根治术中手术风险的评估

Risk assessment of lung cancer combined with pulmonary fibrosis in lung cancer radical surgery

目的:分析肺癌合并肺纤维化患者肺癌根治术的预后,并探讨此类患者手术风险的评估。方法:回顾性分析373例肺癌患者行肺切除术的病理组织,以是否有肺纤维化分为两组(I组和Ⅱ组),对二者术后并发症、临床转归、生存率等相关指标进行比较,并按照不同手术切除方式进行亚组分析。结果:在所有373个标本中,有21例确诊为肺纤维化,两组在年龄[(65±12)岁vs(64±9)岁]、吸烟史(76%vs 63%)、1秒钟用力呼气容积[(2.41±1.25)L·min^(-1) vs(2.49±1.38)L·min^(-1)]、用力肺活量[(3.08±1.53)Lvs(3.44±1.42)L]没有显著差异,但肺纤维化患者男性更多(71%vs 51%,P<0.05)。肺纤维化患者的手术死亡率高于对照组(14%vs 4%,P<0.01),亚组分析显示肺纤维化患者全肺切除术(20%vs 9%,P<0.01)和肺叶切除术(13%vs 4%,P<0.01)死亡率较对照组高。肺纤维化患者术后肺损伤发生率较高(42%vs 5%,P<0.01),住院时间较长[(15.70±4.11)d vs(9.28±3.03)d,P<0.05]。在肺纤维化患者中,5例患者出现术后急性呼吸窘迫综合征,其中3例死亡。术后急性呼吸窘迫综合征的发生与术前低DLCO[(4.01±1.40)mmol·min^(-1)·k Pa^(-1)·L^(-1),(4.5±1.65)mmol·min^(-1)·k Pa^(-1)·L^(-1),P<0.05]和KCO[(0.92±0.33)mmol·min^(-1)·k Pa^(-1)·L^(-1),(1.01±0.46)mmol·min^(-1)·k Pa^(-1)·L^(-1),P<0.05]以及高术前CPI(45.68±7.41,32.22±17.21,P<0.01)有关。结论:肺纤维化患者行肺癌根治术术后发病率和死亡率增加,与术前低气体弥散指标和高CPI有关。术前仔细评估其肺功能受损程度以选择合适的病人,对其行肺癌切除术的生存获益是十分必要的。

Objective:To analyze the prognosis of patients with lung cancer combined with pulmonary fibrosis in lung cancer radical surgery and to evaluate the surgical risk of these patients.Methods:Making retrospective analysis on patients’lung tissue(2010-2016),which were divided into two groups based on pulmonary fibrosis(I andⅡgroup).The postoperative complications,clinical outcomes,survival rates and other related indicators were compared,and subgroup analysis was performed by different surgical excision methods.Results:In all373cases,21cases were diagnosed with pulmonary fibrosis,the two groups showed no significant differences in age[(65±12)years old vs(64±9)years old],smoking(76%vs63%),forced expiratory volume in1second[(2.41±1.25)L·min-1vs(2.49±1.38)L·min-1],forced vital capacity[(3.08±1.53)L vs(3.44±1.42)L].However,there were more male patients with pulmonary fibrosis(71%vs51%,P<0.05).The procedure showed that the mortality rates of patients with pulmonary fibrosis were higher than the control group(14%vs4%,P<0.01).Subgroup analysis showed that the mortality rates in patients with pulmonary fibrosis of pneumonectomy(20%vs9%,P<0.01)and lobectomy(13%vs4%,P<0.01)were higher than the control group.The incidence of acute lung injury in patients with pulmonary fibrosis was higher(42%vs5%,P<0.01),and the length of hospitalization was longer(15.70±4.11vs9.28±3.03days,P<0.05).In patients with pulmonary fibrosis,5patients had postoperative acute respiratory distress syndrome,3of which were fatal.Postoperative acute respiratory distress syndrome occurred with preoperative low DLCO[(4.01±1.40)mmol·min-1·kPa-1·L-1,(4.5±1.65)mmol·min-1·kPa-1·L-1,P<0.05]and KCO[(0.92±0.33)mmol·min-1·kPa-1·L-1,(1.01±0.46)mmol·min-1·kPa-1·L-1,P<0.05],as well as the high preoperative CPI(45.68±7.41,32.22±17.21,P<0.01).Conclusion:The incidence and mortality of postoperative patients with lung fibrosis combined with non-small cell lung cancer are increased due to low preoperative gas dispersion and high CPI.In patients with lung fibrosis combined with lung cancer,it is necessary to select patients by assessing the degree of damage to their lung function.