全腔镜手术与开胸手术治疗食管癌患者术后肺部感染情况及其危险因素分析

Postoperative pulmonary infection and its risk factors in patients with esophageal cancer undergoing total endoscopic surgery and thoracotomy

目的观察全腔镜手术与开胸手术治疗食管癌术后肺部感染的发生情况,并分析影响术后肺部感染的风险因素。方法回顾性分析2020年9月至2023年9月在周口市中心医院接受手术治疗的96例食管癌患者的临床资料,其中接受全腔镜手术患者51例(全腔镜组),开胸手术患者45例(开胸手术组),比较两组患者术后肺部感染情况及血液中中性粒细胞/淋巴细胞(NLR)、血小板与淋巴细胞比值(PLR)、红细胞免疫复合物花环率(RBC-ICR)和红细胞黏附肿瘤细胞花环率(TRR),采用Logistic回归分析影响患者术后肺部感染的危险因素。结果全腔镜组患者术后2d的NLR、PLR水平分别为2.77±0.41、115.46±13.26,明显低于开胸手术组的2.98±0.52、122.87±10.85,差异均有统计学意义(P<0.05);全腔镜组患者术后2d的RBC-ICR水平为(32.46±2.57)%,明显低于开胸手术组的(35.40±2.68)%,而TRR水平为(23.18±3.85)%,明显高于开胸手术组的(19.44±4.42)%,差异均有统计学意义(P<0.05);96例患者术后21例发生感染,经鉴定共检出38株病原菌,其中革兰阴性菌24株(占比63.16%),革兰阳性菌12株(占比31.58%),真菌2株(占比5.26%);全腔镜组11株(革兰阴性菌7株,革兰阳性菌4株)占28.95%,开胸手术组27株(革兰阴性菌17株,革兰阳性菌8株,真菌2株)占71.05%。单因素分析显示,年龄、手术时间、手术方式、辅助化疗、合并糖尿病及术后2 d的NLR、PLR、RBC-ICR、TRR水平与患者术后肺部感染有关(P<0.05);Logistic回归分析结果显示:年龄、手术时间、开胸手术、辅助化疗、合并糖尿病及术后2d的NLR、PLR、TRR水平是术后发生肺部感染的危险因素(P<0.05),术后2 d的RBC-ICR是术后发生肺部感染的保护因素(P<0.05)。结论相比于全腔镜手术,食管癌采用开胸手术更易发生肺部感染,年龄、手术时间、开胸手术、合并糖尿病及术后2 d的NLR、PLR、TRR水平可能是影响术后肺部感染的危险因素。

Objective To observe the occurrence of pulmonary infection after total endoscopic surgery and thoracotomy for esophageal cancer,and to analyze the risk factors affecting postoperative pulmonary infection.Methods The clinical data of 96 patients with esophageal cancer who received surgical treatment in Zhoukou Central Hospital from September 2020to September 2023 were retrospectively analyzed,including 51 patients undergoing total endoscopic surgery(total endoscopic group)and 45 patients receiving thoracotomy(thoracotomy group).The postoperative pulmonary infection status and blood neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),red blood cell immune complex rosette rate(RBC-ICR),and red blood cell adhesion tumor cell rosette rate(TRR)were compared between the two groups.Logistic regression model was used to analyze the high-risk factors affecting postoperative pulmonary infection.Results At 2 days after surgery,the levels of NLR and PLR in total endoscopic group were 2.77±0.41 and 115.46±13.26,which were significantly lower than 2.98±0.52 and 122.87±10.85 in thoracotomy group(P<0.05).The RBC-ICR level at 2 days after surgery[(32.46±2.57)%]in total endoscopic group was significantly lower than that[(35.40±2.68)%]in thoracotomy group,while the TRR level[(23.18±3.85)%]was significantly higher than that[(19.44±4.42)%]in thoracotomy group,with statistically significant differences(P<0.05).Among the 96 patients,21 had infection after surgery,and 38 strains of pathogenic bacteria were identified,including 24 strains of Gram-negative bacteria(63.16%),12 strains of Gram-positive bacteria(31.58%),and 2 strains of fungi(5.26%).There were 11 strains(7 strains of Gram-negative bacteria and 4 strains of Gram-positive bacteria)in total endoscopic group,accounting for 28.95%.There were 27 strains(17 strains of Gram-negative bacteria,8 strains of Gram-positive bacteria,and 2 strains of fungi)in thoracotomy group,accounting for 71.05%.Univariate analysis showed that age,surgical time,surgical method,adjuvant chemotherapy,complication with diabetes mellitus,and NLR,PLR,RBC-ICR,and TRR at 2 days after surgery were related to postoperative pulmonary infection(P<0.05).Logistic regression analysis suggested that age,surgical time,thoracotomy,adjuvant chemotherapy,complication with diabetes mellitus,and NLR,PLR,TRR at 2 days after surgery were risk factors for postoperative pulmonary infection(P<0.05),and RBC-ICR at 2 days after surgery was a protective factor for postoperative pulmonary infection(P<0.05).Conclusion Compared with total endoscopic surgery,thoracotomy for esophageal cancer is more likely to cause pulmonary infection.Age,surgical time,thoracotomy,complication with diabetes mellitus,and NLR,PLR TRR at 2 days after surgery may be risk factors affecting postoperative pulmonary infection.