肺癌患者胸腔镜肺切除术后闭式引流切口愈合不良影响因素分析

Factors associated with poor healing of operative incision with closed drainage after video-assisted thoracoscopic pneumonectomy in patients with lung cancer

目的探讨肺癌患者胸腔镜肺切除术后闭式引流切口愈合不良的影响因素,为临床干预提供依据。方法选取2022年1月1日至2023年12月31日经病理诊断为肺癌并行胸腔镜肺切除术的704例患者为研究对象。根据是否发生闭式引流切口愈合不良将患者分为愈合不良组(128例)和愈合组(576例)。对可能影响患者术后闭式引流切口愈合不良因素,如性别、年龄、体质量指数(body mass index,BMI)、其他既往史(手术侧乳腺癌根治性切除术史、免疫系统疾病)、高血压、糖尿病、吸烟史、手术时间、切除范围、闭式引流位置、引流管切口缝合针数、留置引流管时间、引流管口拆线时间、术前白蛋白水平进行单因素分析及多因素Logistic回归分析。结果单因素分析结果显示,年龄、BMI、糖尿病与发生闭式引流切口愈合不良有关(P<0.05)。多因素Logistic回归分析结果显示,年龄(OR=1.615,95%CI:1.081~2.413,P=0.019)、BMI(OR=2.086,95%CI:1.382~3.148,P<0.001)、糖尿病(OR=2.103,95%CI:1.216~3.638,P=0.008)是闭式引流切口愈合不良独立危险因素。结论年龄、BMI、糖尿病是肺癌患者行胸腔镜术后闭式引流切口愈合不良的独立危险因素,医护人员应重点关注,围手术期做好准备工作,术后关注伤口变化,给予针对性措施,以减少闭式引流切口愈合不良的发生。

Objective To explore the factors associated with poor healing of closed drainage incision after video-assisted thoracoscopic surgery(VATS)for lung cancer patients,and to provide basis for clinical intervention.Methods A total of 704 patients who were pathologically diagnosed as primary lung cancer and underwent thoracoscopic lung resection from January 1,2022 to December 31,2023 were selected as the research objects.Patients were categorized into a poor healing group(128 cases)and a healing group(576 cases)according to whether or not poor healing of the closed drainage incision occurred.A monofactor analysis and logistic regression analysis were performed to analyze the factors that may affect the postoperative healing of closed drainage incisions,such as patients'gender,age,body mass index(BMI),past history(history of radical mastectomy,immune system diseases),hypertension,diabetes,smoking history,operation time,resection scope,location of closed drainage,number of sutures at the surgical incision of the drainage tube,duration of indwelling drainage tube,duration from surgery to remove sutures,and preoperative albumin.Results Results of monofactor analysis showed that age,BMI and diabetes were associated with poor healing of operative incision with closed drainage(P<0.05).Logistic regression analysis showed that age(OR=1.615,95%CI:1.081-2.413,P=0.019),BMI(OR=2.086,95%CI:10.382-3.148,P<0.001),diabetes(OR=2.103,95%CI:1.216-3.638,P=0.008)were independent risk factor for poor healing of closed drainage incision.Conclusions Age,BMI and diabetes are independent risk factors for poor wound healing after thoracoscopic surgery and indwelling closed drainage in lung cancer patients.Medical staff should pay attention to them,make well preparations in perioperative period,pay attention to postoperative wound changes,and give targeted treatment to reduce the incidence of poor wound healing of operative incision with closed drainage.