卵巢癌术后发生胸腔积液危险因素分析

Risk factors of pleural effusion after operation of ovarian cancer

目的探讨卵巢癌患者接受肿瘤细胞减灭术(CRS)联合腹腔热灌注化疗(HIPEC)术后发生胸腔积液的危险因素。方法分析首都医科大学附属北京世纪坛医院卵巢癌数据库中接受CRS+HIPEC的初治或复发卵巢癌临床病例数据。术后发生胸腔积液者纳入胸腔积液组,其余纳入非胸腔积液组。利用单因素和多因素Logistic回归对数据进行分析。结果共纳入病例106例,年龄为(56.08±9.96)岁。研究对象术后胸腔积液发生率为51.89%(55/106),其中双侧胸腔积液占比63.64%(35/55),左侧胸腔积液占比25.45%(14/55),右侧胸腔积液占比10.91%(6/55)。单因素分析显示初治/复发、手术时间、术中输液量、谷丙转氨酶、膈肌累及、腹水、低白蛋白血症比较差异有统计学意义(P<0.05),多因素Logistic回归分析结果表明:右侧膈肌累及(OR=5.66,95%CI:1.10~29.39)、腹水(OR=4.21,95%CI:1.05~16.83)、复发(OR=4.66,95%CI:1.32~16.42)是术后发生胸腔积液的独立危险因素。结论右侧膈肌累及、腹水和复发是卵巢癌行CRS+HIPEC术后发生胸腔积液的独立危险因素,术后应加强对复发卵巢癌患者,尤其是存在右侧膈肌受累患者的关注,及时引流腹水,防止胸腔积液的发生发展。

Objective To explore the risk factors of pleural effusion after cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)in patients with ovarian cancer.Methods To analyze the clinical data of primary or recurrent ovarian cancer who received CRS+HIPEC in the ovarian cancer database of Beijing Shijitan Hospital.Postoperative patients with pleural effusion were included in the pleural effusion group,and the rest in the non-pleural effusion group.We used univariate and multivariate Logistics regression to analyze the data.Results A total of 106 patients were included in this study,with an average age of(56.08±9.96)years.The incidence of postoperative pleural effusion was 51.89%(56/106),of which bilateral pleural effusion accounted for 63.64%(35/55),left pleural effusion accounted for 25.45%(14/55),and right pleural effusion accounted for 10.91%(6/55).Univariate analysis showed that initial/recurrence,operative time,intraoperative fluid volume,glutamic-pyruvic transaminase,diaphragmatic involvement,ascites and hypoalbuminemia had statistical significance(P<0.05).The results of multivariate logistic regression analysis showed that right diaphragmatic involvement(OR=5.66,95%CI:1.10-29.39),ascites(OR=4.21,95%CI:1.05-16.83),and recurrence(OR=4.66,95%CI:1.32-16.42)were independent risk factors for postoperative pleural effusion.Conclusion Patients with right diaphragmatic involvement,ascites and recurrence are independent risk factors for pleural effusion after CRS+HIPEC for ovarian cancer.Postoperative attention should be paid to patients with recurrent ovarian cancer,especially those with involvement of the right diaphragm,and timely drainage of ascites to prevent the occurrence and development of pleural effusion.