胸部恶性肿瘤胸腔镜手术后肺栓塞发生的危险因素及治疗效果分析

Analysis of risk factors and therapeutic effects of pulmonary embolism after thoracoscopic surgery for thoracic malignant tumors

目的:探讨胸部恶性肿瘤患者胸腔镜手术后肺栓塞(pulmonary embolism,PE)的危险因素及临床治疗效果。方法:收集2014年1月至2018年10月326例食管癌、肺癌胸腔镜手术患者的临床资料,采用多因素logistic回归分析患者发生PE的危险因素。结果:326例患者中201例食管癌、125例肺癌;17例食管癌患者、5例肺癌患者术后发生PE;食管癌与肺癌患者胸腔镜手术后PE发生率差异无统计学意义(P>0.05);PE组>60岁的患者多于无PE组(P<0.05);PE组患者血氧分压低于无PE组(P<0.05);PE组患者白细胞、血浆DD水平、合并糖尿病患者的比例高于无PE组(P<0.05)。多因素logistic回归分析显示,血氧分压降低、白细胞水平升高、血浆DD水平升高、合并糖尿病是胸腔镜手术后患者发生PE的独立危险因素。22例PE患者治疗效果均较好。结论:胸部恶性肿瘤胸腔镜手术后PE发生的危险因素包括血氧含量较低、感染、血浆DD水平较高及合并糖尿病,对预防胸部恶性肿瘤胸腔镜手术后PE的发生具有指导作用,及时、规范的抗凝治疗有助于PE患者的恢复。

Objective:To investigate the risk factors and therapeutic effects of pulmonary embolism(PE)after thoracoscopic surgery for thoracic malignant tumors.Methods:The clinical data of 326 patients with esophageal cancer and lung cancer after thoracoscopic surgery from Jan.2014 to Oct.2018 were collected.Multivariate logistic regression was used to analyze the risk factors of PE.Results:Among the 326 patients,201 had esophageal cancer and 125 had lung cancer.17 patients with esophageal cancer and 5 patients with lung cancer had PE after thoracoscopic surgery,the incidence of PE in esophageal cancer patients after thoracoscopic surgery was not significantly different from that in patients with lung cancer(P>0.05).The number of patients older than 60 years in PE group was significantly more than that in PE-free group(P<0.05).The blood oxygen partial pressure of PE group was significantly lower than that of the PE-free group(P<0.05).The level of white blood cell and plasma D-dimer,and percentage of patients with diabetes in the PE group were significantly higher than those in the PE-free group(P<0.05).Multivariate logistic regression analysis showed that decreasing blood oxygen partial pressure,increasing of white blood cell and plasma D-dimer level,and diabetes mellitus were independent risk factors for postoperative PE after thoracoscopic surgery.22 patients with PE all had good treatment results.Conclusions:The risk factors for PE in patients with thoracic malignant tumors after thoracic surgery are low blood oxygen level,infection,high plasma D-dimer level and diabetes.It has a guiding value on the prevention of PE after thoracoscopic surgery for thoracic malignant tumors.After the occurrence of PE,timely and normative anticoagulation therapy can help PE patients recover.