手术时间安排对早期肺癌胸腔镜术后近期并发症的影响:倾向评分匹配研究

Effect of operation schedule on the recent complications of thoracoscopic lobectomy for early stage non-small cell lung cancer:a propensity score matching study

目的探索早期肺癌患者在不同时间段接受电视辅助胸腔镜(video-assisted thoracoscopic surgery,VATS)肺叶切除术后近期并发症发生情况。方法选取2013年6月至2017年10月在北京大学人民医院胸外科行VATS肺叶切除的730例早期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者为研究对象,回顾性收集临床资料,统计术后近期并发症发生率,采用倾向评分匹配(propensity score matching,PSM)方法比较不同手术时间段(下午4点之前或者下午4点之后,工作日或者周末)与术后近期并发症之间的相关性;同时采用单因素及多因素logistic回归方法分析术后并发症的独立危险因素。结果730例早期NSCLC患者术后1个月内共出现并发症162例(22.2%),其中有53例(7.3%)是主要并发症。将所有患者的术前临床变量进行PSM后,工作日或者周末手术患者术后近期并发症发生率差异无统计学意义(18.7%对23.9%,P=0.267),下午4点之前和下午4点之后进行手术的患者术后近期并发症发生率差异无统计学意义(22.1%对27.9%,P=0.337)。术前合并冠心病、手术切除部位是术后并发症的独立危险因素。结论早期肺癌患者行VATS肺叶切除后近期并发症发生率约22.2%,手术时间段的选择不影响术后近期并发症的发生。

Objective To investigate different incidences of recent complications after thoracoscopic lobectomy at different operation schedules in patients with early stage non-small cell lung cancer(NSCLC).Methods A total of 730 patients with early stage NSCLC who underwent thoracoscopic lobectomies in the Department of Thoracic Surgery,Peking University People's Hospital from June 2013 to October 2017 were enrolled.Clinical data were collected retrospectively to calculate the incidence of postoperative complications.Meanwhile,the effects of different operation time periods(before 4pm or after 4pm,working day or weekend)on complications were compared,and the propensity score matching method was used to eliminate the confusion factors that may cause result bias.Univariate and multivariate logistic regression methods were used to analyze the independent risk factors of postoperative complications.Results 162 patients(22.2%)had complications within one month after thoracoscopic surgeries,and 53(7.3%)of them were major complications.After the propensity scores of the preoperative clinical factors were matched,there was no significant difference in the incidence of complications between weekdays and weekends(18.7%vs 23.9%,P=0.267).There was also no significant difference in the effect of complications between the group before 4pm and group after 4pm on surgery(22.1%vs 27.9%,P=0.337).Conclusion The incidence of recent complications in patients with early stage NSCLC after thoracoscopic lobectomy was as acceptable as 22.2%.The choice of operation schedules did not affect the postoperative complications.