术后引流量及肺功能预测值对非小细胞肺癌病人胸腔镜肺叶切除术后肺部并发症的预测价值

Predictive value of postoperative drainage volume and lung function for pulmonary complications after thoracoscopic lobectomy in patients with non-small cell lung cancer

目的探讨术后引流量及肺功能预测值对非小细胞肺癌(NSCLC)病人胸腔镜肺叶切除术(VATSL)后肺部并发症(PPCs)的预测价值。方法2017年6月~2022年6月间我院收治的NSCLC病人80例,均行VATS治疗。根据病人术后PPCs的发生情况分为发生组及未发生组。所有NSCLC病人均于术前1周检查病人肺功能指标,记录术后3天引流量,Logistic回归分析VATSL后发生PPCs的影响因素,根据ROC曲线分析术后引流量及肺功能对NSCLC病人VATSL后发生PPCs的预测价值。结果80例病人VATSL后57例未发生PPCs,23例发生PPCs,PPCs发生率为28.75%;两组病人性别、年龄,BMI,手术时间,术中出血量,住院时间,临床分期,糖尿病史,高血压史,吸烟史及肺功[肺活量(VC),用力肺活量(FVC),第1秒用力呼气容积(FEV1),FEV1/FVC,最大通气量(MVV)]比较,差异无统计学意义(P>0.05);发生组呼气流量峰值(PEF)水平低于未发生组,术后3天引流量多于未发生组,差异有统计学意义(P<0.05);Logistic回归分析发现,PEF、术后3天引流量是NSCLC病人VATSL后发生PPCs的独立危险因素(P<0.05)。经ROC分析显示,PEF、术后3天引流量评估NSCLC病人VATSL后发生PPCs的AUC值分别为0.788,0.815,95%CI为0.682~0.871,0.713~0.893,二者联合预测的AUC值为0.908,95%CI为0.823~0.961。结论术后引流量及PEF对于预测NSCLC病人VATSL后PPCs的发生均有一定的参考价值,联合用于预测VATSL后PPCs发生的价值更高。

Objective To explore the predictive value of postoperative drainage volume and lung function for pulmonary complications(PPCs)after thoracoscopic lobectomy(VATSL)in patients with non-small cell lung cancer(NSCLC).Methods The clinical data of 80 NSCLC patients with VATSL treated in Suzhou Hospital of Integrated Traditional Chinese and Western Medicine from June 2017 to June 2022 were collected.According to the occurrence of postoperative PPCs,patients were divided into the occurrence group and the non-occurrence group.Lung function indexes of all NSCLC patients were examined one week before surgery,and postoperative drainage volume of 3 days after operation was recorded.The influencing factors of PPCs after VATSL were analyzed by Logistic regression,and the predictive value of postoperative drainage volume and lung function on PPCs after VATSL in NSCLC patients was analyzed according to ROC curve.Results After VATSL,there were 57 cases without PPCs and 23 cases with PPCs,the incidence of PPCs was 28.75%.There was no significant differencein gender,age,BMI,operation time,intraoperative blood loss,length of hospital stay,clinical stage,history of diabetes,history of hypertension,smoking history and lung function between the two groups[vital capacity(VC),forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),FEV1/FVC,maximum volume of gas(MVV)](P>0.05).The peak expiratory flow(PEF)level in the occurrence group was lower than that in the non-occurrence group,and the drainage flow of 3 days after operation was higher than that in the non-occurrence group(P<0.05).Logistic regression analysis showed that PEF and drainage volume of 3 days after operation were independent risk factors for PPCs after VATSL in NSCLC patients(P<0.05).ROC analysis showed that the AUC values of PPCs after PEF and drainage volume of 3 days after operation assessment of VATSL in NSCLC patients were 0.788 and 0.815,respectively,and 95%CI were 0.682-0.871 and 0.713-0.893.The combined prediction of AUC was 0.908 and 95%CI was 0.823-0.961.Conclusion Both postoperative drainage volume and PEF have certain reference value for predicting the occurrence of PPCs after VATSL in NSCLC patients,and the combined value is higher for predicting the occurrence of PPCs after VATSL.