达芬奇机器人与电视胸腔镜非小细胞肺癌术后慢性咳嗽危险因素分析及应对策略

Risk factors and prevention strategies for chronic cough after robotic versus videoassisted thoracic surgery in non-small cell lung cancer patients

目的分析微创技术下非小细胞肺癌(non-small cell lung cancer,NSCLC)术后慢性咳嗽的危险因素,探讨可能的防治办法。方法纳入2018年于我院行微创手术的128例NSCLC患者,其中男63例、女65例,平均年龄(60.82±9.89)岁。根据手术方式不同,将患者分为达芬奇机器人(robot-assisted thoracic surgery,RATS)组(56例)和电视胸腔镜(video-assisted thoracic surgery,VATS)组(72例)。应用视觉模拟评分(visual analogue scale,VAS)评估患者术后咳嗽情况,分析比较两组咳嗽及围手术期相关指标差异,并针对术后慢性咳嗽情况进行单因素分析和多因素logistic回归分析,探讨防治策略。结果共有61例(47.7%)患者确诊为术后慢性咳嗽,其中RATS组有44.6%的患者出现术后慢性咳嗽,VATS组有50.0%的患者出现术后慢性咳嗽,两组差异无统计学意义(P>0.05)。与VATS组相比,RATS组气管插管时间更短(P=0.009),术中出血量更少(P<0.001)。单因素分析显示,患者的年龄(P=0.014)、手术范围(P=0.021)、淋巴结清除数(P=0.015)、术前是否咳嗽(P=0.006)、术中气管插管时间(P=0.004)是术后慢性咳嗽的影响因素。多因素logistic回归分析显示,年龄<57岁(OR=3.006,95%CI1.294~6.986,P=0.011)、术前咳嗽(OR=3.944,95%CI 1.548~10.048,P=0.004)、气管插管时间≥172 min(OR=2.316,95%CI 1.027~5.219,P=0.043)、肺叶切除(OR=2.651,95%CI 1.052~6.681,P=0.039)是术后慢性咳嗽的独立危险因素。结论RATS与VATS NSCLC术后慢性咳嗽情况无差异,但RATS患者术中出血量少、气管插管时间短。年龄<57岁、术前存在咳嗽症状、肺叶切除、气管插管时间≥172 min的NSCLC患者术后更易出现慢性咳嗽。

Objective To analyze risk factors for chronic cough after minimally invasive resection of non-small cell lung cancer(NSCLC)and explore the possible prevention measures.Methods A total of 128 NSCLC patients who received minimally invasive resection in 2018 in our hospital were enrolled,including 63 males and 65 females with an average age of 60.82±9.89 years.The patients were allocated into two groups:a robot-assisted thoracic surgery(RATS)group(56 patients)and a video-assisted thoracic surgery(VATS)group(72 patients).Chronic cough was assessed by visual analogue scale(VAS),meanwhile,other perioperative indicators were compared between the two groups.Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative chronic cough and explore the prevention strategies.Results Overall,61(47.7%)patients were diagnosed with chronic cough after surgery,including 25(44.6%)patients in the RATS group and 36(50.0%)patients in the VATS group,and the difference was not statistically significant(P>0.05).Compared with the VATS group,the RATS group got shorter endotracheal intubation time(P=0.009)and less blood loss(P<0.001).The univariate analysis showed that age(P=0.014),range of surgery(P=0.021),number of dissected lymph nodes(P=0.015),preoperative cough(P=0.006),endotracheal intubation time(P=0.004)were the influencing factors for postoperative chronic cough.The multivariate analysis showed that age<57 years(OR=3.006,95%CI 1.294-6.986,P=0.011),preoperative cough(OR=3.944,95%CI 4.548-10.048,P=0.004),endotracheal intubation time≥172 min(OR=2.316,95%CI 1.027-5.219,P=0.043),lobectomy(OR=2.651,95%CI 1.052-6.681,P=0.039)were the independent risk factors for chronic cough.Conclusion There is no statistical difference in postoperative chronic cough between the RATS and VATS groups.The RATS group gets less blood loss and shorter endotracheal intubation time.Patients with younger age(<57 years),preoperative cough,lobectomy,and longer duration of endotracheal intubation(≥172 min)are more likely to have chronic cough after surgery.