慢性阻塞性肺疾病对食管癌患者术后近期预后的影响

Impact of chronic obstructive pulmonary disease on postoperative complications and short-term prognosis in patients undergoing oesophagectomy

目的分析合并慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)对食管癌根治术后并发症及近期预后影响,为合并不同程度COPD食管癌患者的围手术期管理提供临床参考。方法回顾性分析2015年1月—2018年1月于重庆医科大学附属第一医院胸心外科行食管癌根治术163例患者的临床资料,其中男124例、女39例,中位年龄64(23.8)岁。根据术前是否合并COPD,将患者分为COPD组(n=87)和非COPD组(n=76),收集临床资料,对比分析两组间术后并发症及2年生存情况。结果COPD组患者术后出现主要并发症(肺部感染、呼吸衰竭、心律失常和吻合口瘘)发生率均较非COPD组高(P均<0.05);Spearman相关性分析结果显示,术前COPD严重程度与食管癌患者术后并发症发生率呈正相关性(r=0.437,P<0.001);其中合并重度COPD的食管癌患者术后呼吸衰竭发生率及死亡率均高于非COPD者以及轻、中度COPD患者(P均<0.05);COPD组食管癌患者术后2年生存率低于非COPD组(56.1%vs.78.5.%,P=0.001),且COPD严重程度与术后2年生存率呈负相关。结论合并COPD显著增加食管癌患者术后并发症发生率,不利于患者预后,且COPD严重程度与术后并发症及术后2年生存率存在相关性。

Objective To provide clinical reference for the perioperative management of esophageal cancer patients with different stages of chronic obstructive pulmonary disease(COPD)through investigating the impact of COPD on postoperative complications and survival in esophageal cancer patients undergoing oesophagectomy.Methods The clinical data of 163 patients who underwent radical resection of esophageal cancer in our department from January 2015 to January 2018 were retrospectively analyzed,including 124 males and 39 females,with a median age of 64 years(IQR:23.8 years).They were divided into a COPD group(n=87)and a non-COPD group(n=76)according to the presence of COPD before operation.The clinical data were collected and the postoperative complications and 2-year survival between the two groups were compared and analyzed.Results The incidence of major postoperative complications(pulmonary infection,respiratory failure,arrhythmia and anastomotic leakage)in the COPD group were higher than those in the non-COPD group(all P<0.05).Spearman correlation analysis showed that the severity of preoperative COPD was positively correlated with the incidence of postoperative complications in patients with esophageal cancer(r=0.437,P<0.001).The incidence of postoperative respiratory failure and mortality in patients with severe COPD were significantly higher than those in patients without COPD and those with mild or moderate COPD.The 2-year survival rate of patients with esophageal cancer in the COPD group was lower than that in the non-COPD group(56.1%vs.78.5.%,P=0.001),and the severity of COPD was negatively correlated to the survival rate.Conclusion COPD significantly increases the incidence of postoperative complications in patients with esophageal cancer,which is not conducive to the prognosis of patients,and the severity of COPD is correlated with postoperative complications and 2-year survival rate.