食管癌微创术后肺部并发症的危险因素分析

Risk Factors of Pulmonary Complications after Minimally Invasive Surgery for Esophageal Cancer

目的:探讨食管癌微创术后肺部并发症的危险因素。方法:回顾性分析2017年1月-2020年3月行食管癌切除术的112例患者的临床资料。所有患者微创食管癌切除术后按照是否发生术后肺部并发症分为两组,未发生术后肺部并发症者作为对照组,发生术后肺部并发症者作为研究组。整理两组临床资料,分析可能引发术后肺部并发症的危险因素。结果:本次研究112例患者发生术后肺部并发症的共19例(17.0%)。单因素分析显示,两组年龄、ASA分级、肺结核病史、糖尿病、吸烟指数≥400、FEV1/FVC、FEV1、FEV1%pred、FVC、FVC%pred、通气方式比较,差异均有统计学意义(P<0.05)。两组性别、浸润深度、TNM分期、肿瘤位置、术前化疗情况比较,差异均无统计学意义(P>0.05)。经logitics多因素分析,FEV1%pred较低、单肺通气、ASA分级≥Ⅲ级、存在肺结核病史、合并糖尿病、长期大量吸烟、年龄≥65岁为食管癌微创术后肺部发生并发症的危险因素(P<0.05)。结论:引发食管癌微创术后肺部并发症发生的危险因素有FEV1%pred较低、单肺通气、ASA分级≥Ⅲ级、存在肺结核病史、合并糖尿病、长期大量吸烟、年龄≥65岁。

Objective:To investigate the risk factors of pulmonary complications after minimally invasive surgery for esophageal cancer.Method:The clinical data of 112 patients who underwent esophagectomy from January 2017 to March 2020 were retrospectively analyzed.All patients were divided into two groups according to the occurrence of postoperative pulmonary complications after minimally invasive esophagectomy.The patients without postoperative pulmonary complications were served as the control group,and the patients with postoperative pulmonary complications were taken as the study group.The clinical data of two groups were collated and the risk factors of postoperative pulmonary complications were analyzed.Result:There were 19 cases (17.0%) of 112 patients with postoperative pulmonary complications.Univariate analysis showed that there were significant differences in age,ASA grade,tuberculosis history,diabetes mellitus,smoking index ≥ 400,FEV1/FVC,FEV1,FEV1%pred,FVC,FVC%pred,ventilation mode between two groups (P<0.05).There were no significant differences in gender,depth of invasion,TNM stage,tumor location and preoperative chemotherapy between two groups (P>0.05).According to logistic multivariate analysis,low FEV1%pred,single lung ventilation,ASA grade ≥Ⅲ,history of pulmonary tuberculosis,diabetes mellitus,long-term heavy smoking,age ≥65 years old were the risk factors of pulmonary complications after esophagectomy (P<0.05).Conclusion:Low FEV1%pred,single lung ventilation,ASA grade ≥Ⅲ,history of pulmonary tuberculosis,diabetes mellitus,long-term heavy smoking,age ≥65 years old are the risk factors of pulmonary complications after minimally invasive surgery for esophageal cancer.