机器人辅助肺段切除术后肺部并发症的危险因素分析

Analysis of risk factors for complications after robot-assisted segmentectomy

目的分析机器人辅助肺段切除术后肺部并发症的危险因素。方法回顾性分析我院2015年6月至2019年7月行机器人辅助解剖性肺段切除术的患者207例,其中男69例、女138例,中位年龄54.0岁。分析临床病理因素与术后发生持续性肺漏气、胸腔积液、肺部感染的关系。结果术后20例(9.7%)患者出现持续性肺漏气(持续超过5 d),17例(8.2%)出现胸腔积液,4例(1.9%)出现肺部感染。单因素logistic回归分析显示,体重指数(body mass index,BMI,P=0.018)、第一秒用力呼气容积占预计值百分比(FEV1%,P=0.024)、N1组淋巴结采样数(P=0.008)与机器人辅助肺段切除术后持续性肺漏气相关,病理显示良性病变是胸腔积液的危险因素(P=0.013),淋巴结采样站数与肺部感染的发生显著相关(P=0.035)。多因素logistic回归分析显示,BMI(OR=0.73,P=0.012)、N1组淋巴结采样数(OR=1.38,P=0.001)分别与患者术后持续性肺漏气呈负相关和正相关关系。结论机器人辅助肺段切除术后肺部并发症发生率较低。BMI越小、N1组淋巴结采样数越多,机器人辅助肺段切除术后出现持续性肺漏气的概率越大;良性病变、淋巴结采样站数多分别是胸腔积液、肺部感染的危险因素,应在围术期注意防治相应并发症。

Objective To analyze the risk factors for complications after robotic segmentectomy.Methods Clinical data of 207 patients undergoing robot-assisted anatomical segmentectomy in our hospital from June 2015 to July 2019 were retrospectively analyzed,including 69 males and 138 females with a median age of 54.0 years.The relationship between clinicopathological factors and prolonged air leakage,pleural effusion,and pulmonary infection after surgery was analyzed.Results After robot-assisted segmentectomy,20(9.7%)patients developed prolonged air leakage(>5 d),17(8.2%)patients developed pleural effusion,and 4(1.9%)patients developed pulmonary infection.Univariate logistic regression showed that body mass index(BMI,P=0.018),FEV1%(P=0.024),number of N1 lymph nodes resection(P=0.008)were related to prolonged air leakage after robot-assisted segmentectomy.Benign lesion was a risk factor for pleural effusion(P=0.013).The number of lymph node sampling stations was significantly related to the incidence of pulmonary infection(P=0.035).Multivariate logistic analysis showed that the BMI(OR=0.73,P=0.012)and N1 lymph node sampling(OR=1.38,P=0.001)had a negative and positive relationship with prolonged air leakage after robot-assisted segmentectomy,respectively.Conclusion The incidence of pulmonary complications after robot-assisted segmentectomy is low.The lower BMI and more N1 lymph node sampling is,the greater probability of prolonged air leakage is.Benign lesions and more lymph node sampling stations are risk factors for pleural effusion and lung infection,respectively.Attention should be paid to the prevention and treatment of perioperative complications for patients with such risk factors.