胸腔镜肺癌根治术术中转开胸手术的危险因素调查

Risk factors of conversion from thoracoscopic radical resection to thoracotomy for lung cancer

目的调查胸腔镜肺癌根治术术中转开胸手术的危险因素。方法回顾性选取2018年1月-2021年1月共590例非小细胞肺癌患者,进行胸腔镜肺癌根治术,统计术中转开胸手术的病例,并根据是否转开胸手术设为观察组与对照组。比较两组性别、年龄、胸膜粘连情况、肺结核病史等临床资料,采用单因素分析、多因素分析调查术中转开胸手术的危险因素。结果本研究590例患者胸腔镜肺癌根治术术中120例转开胸手术;观察组与对照组年龄、胸膜粘连分级、肺结核病史、肿瘤位于肺上叶、门钉淋巴结、袖状肺叶切除、肺癌解剖学部位、肿瘤最大径、叶间裂发育不全、淋巴结与周围组织致密连接差异具有统计学意义(P<0.05);两组肿瘤类型、吸烟史、性别、TNM分期差异无统计学意义(P>0.05);多因素分析显示,胸膜粘连分级≥4级、肺结核病史、肿瘤位于肺上叶、门钉淋巴结、袖状肺叶切除、叶间裂发育不全、淋巴结与周围组织致密连接是胸腔镜肺癌根治术术中转开胸手术的危险因素。结论胸腔镜肺癌根治术术中有部分患者需要转开胸手术,危险因素包括胸膜粘连、肺结核病史、肿瘤位于肺上叶、门钉淋巴结、袖状肺叶切除等,应针对相关危险因素及时作出预判与决定。

Objective To investigate the risk factors of conversion from thoracoscopic radical resection to thoracotomy.Methods A total of 590 patients with non-small cell lung cancer from January 2018 to January 2021 were retrospectively selected.The patients who were converted to thoracotomy were divided into an observation group and a control group.The clinical data of gender,age,pleura adhesion,and tuberculosis were compared between the two groups.Univariate analysis and multivariate analysis were used to investigate the risk factors of conversion to thoracotomy.Results Among the 590 patients who underwent thoracoscopic radical resection of lung cancer,120 were converted to thoracotomy.There was a significant difference between the observation group and the control group in the age,pleura adhesion level,pulmonary tuberculosis history,tumor location in the upper lobe of the lung,portal nail lymph node,sleeve lobectomy,anatomical location of lung cancer,the maximum diameter of tumor,interlobar fissure dysplasia and tight connection between lymph nodes and surrounding tissues(P<0.05).There was no significant difference in tumor type,smoking history,gender,and TNM stage between the two groups(P>0.05);Multivariate analysis showed that pleural adhesion grade 4 or more,history of pulmonary tuberculosis,tumor located in the upper lobe of lung,portal nail lymph node and sleeve lobectomy,the maximum diameter of tumor,interlobar fissure dysplasia and tight connection between lymph nodes and surrounding tissues were risk factors for thoracotomy in thoracoscopic lung cancer surgery.Conclusion During thoracoscopic lung cancer radical surgery,some patients need to switch to thoracic surgery.The risk factors include pleural adhesion,history of pulmonary tuberculosis,tumor located in the upper lobe of the lung,portal nail lymph node,and sleeve lobectomy.