中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

胸腔镜肺叶切除术后引流量与术后肺部并发症的关系及价值探讨

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目的 旨在探讨肺癌患者术后第 1 d(postoperative day 1,POD1)引流量与术后肺部并发症(postoperative pulmonary complications,PPCs)的关系,为有效的预测 PPCs 提供参考。 方法 回顾性分析成我院胸外科 2014 年 1 月至 2018 年 6 月 254 例行电视辅助胸腔镜手术(VATS)肺叶切除的非小细胞肺癌患者的临床资料。根据术后是否发生 PPCs,将患者分为 PPCs 组 51 例[男 33 例、女 18 例,年龄(65.2±8.2)岁],non-PPCs 组 203 例[男 110 例、女 93 例,年龄(62.4±8.2)岁]。分析 POD1 引流量与肺部感染、肺不张、胸腔积气/积液、肺漏气等 PPCs 的相关性。 结果 PPCs 组的 POD1 引流量明显高于 non-PPCs 组(337.5±127.4 mlvs.208.7±122.9 ml,P=0.000)。Logistic 回归分析结果显示,POD1 引流量是发生 PPCs 的危险因素,受试者工作特征(ROC)曲线结果显示 POD1 引流量 265 ml 是预测发生 PPCs 的临界点,≤265 ml 组的 PPCs 发生率明显低于引流量>265 ml 组(8.3%vs.43.0%,P=0.000)。 结论 POD1 引流量与肺癌患者肺叶切除术后发生 PPC 相关,POD1 引流液大于 265 ml 可辅助预测 PPCs 的发生。

Objective To investigate the correlation of the postoperative day 1 (POD1) drainage volume and postoperative pulmonary complications (PPCs). Methods The clinical data of 254 non-small cell lung cancer (NSCLC) patients undergoing thoracoscopic lobectomy at our department from January 2014 to June 2018 were retrospectively reviewed. According to whether there were PPCs after operation, patients were divided into a PPCs group (51 patients, 33 males and 18 females, aged 65.2±8.2 years) and non-PPCs group (203 patients, 110 males and 93 females, aged 62.4±8.2 years). The correlation between POD1 drainage volume and PPCs were analyzed. Results The POD1 drainage volume in the PPCs group was significantly higher than in the non-PPCs group (337.5±127.4 mlvs.208.6±122.9 ml, P=0.000). The result of regression analysis showed that POD1 drainage volume was an independent risk factor for the occurrence of PPCs. Receiver operating characteristic curve (ROC curve) analysis showed that POD1 drainage volume of 265 ml was the cut-off point to predict PPCs. The rate of PPCs in the group of POD1 drainage volume less than 265 ml was significantly higher than that in the group of drainage volume more than 265 ml (8.3%vs.43.0%, P=0.000). Conclusion The drainage volume was closely related to the occurrence of PPCs, which can be used to predict the occurrence of PPCs.

关键词: 肺肿瘤; 术后肺部并发症; 胸腔引流量

Key words: Pulmonary neoplasm; postoperative pulmonary complications; postoperative drainage volume

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1. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2. Morikawa T. Thoracoscopic surgery for lung cancer. Ann Thorac Cardiovasc Surg, 2006, 12(6): 383-387.
3. Stéphan F, Boucheseiche S, Hollande J, et al. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest, 2000, 118(5): 1263-1270.
4. 苏建华, 喻鹏铭, 周渝斌, 等. 影响肺癌手术住院费用和快速康复的临床因素分析. 中国肺癌杂志, 2014, 17(7): 536-540.
5. 时辉, 梅龙勇, 车国卫. 肺癌术后胸腔闭式引流术应用的新观念. 中国肺癌杂志, 2010, 13(11): 999-1003.
6. 赵永生, 刘伦旭. 肺叶切除术后胸腔引流的管理. 中国胸心血管外科临床杂志, 2013, 20(3): 338-342.
7. Yang SM, Wang ML, Hung MH, et al. Tubeless uniportal thoracoscopic wedge resection for peripheral lung nodules. Ann Thorac Surg, 2017, 103(2): 462-468.
8. Murakami J, Ueda K, Tanaka T, et al. The validation of a no-drain policy after thoracoscopic major lung resection. Ann Thorac Surg, 2017, 104(3): 1005-1011.
9. Ueda K, Hayashi M, Tanaka T, et al. Omitting chest tube drainage after thoracoscopic major lung resection. Eur J Cardiothorac Surg, 2013, 44(2): 225-229.
10. Watanabe A, Watanabe T, Ohsawa H, et al. Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung. Eur J Cardiothorac Surg, 2004, 25(5): 872-876.
11. Zhi XY, Yu JM, Shi YK. Chinese guidelines on the diagnosis and treatment of primary lung cancer (2015 version). Cancer, 2015, 121(Suppl 17): 3165-3181.
12. Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy. Surg Oncol, 2010, 19(2): e71-e77.
13. 周洪霞, 杨梅, 廖虎, 等. 胸腔镜肺叶切除术后 16F 尿管胸腔引流可行性的前瞻性队列研究. 中国胸心血管外科临床杂志, 2016, 23(4): 334-340.
14. Nakamura H, Taniguchi Y, Miwa K, et al. The 19Fr Blake drain versus the 28Fr conventional drain after a lobectomy for lung cancer. Thorac Cardiovasc Surg, 2009, 57(2): 107-109.
15. Xie HY, Xu K, Tang JX, et al. A prospective randomized, controlled trial deems a drainage of 300 ml/day safe before removal of the last chest drain after video-assisted thoracoscopic surgery lobectomy. Interact Cardiovasc Thorac Surg, 2015, 21(2): 200-205.
16. Agostini P, Cieslik H, Rathinam S, et al. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? Thorax, 2010, 65(9): 815-818.
17. Li S, Jiang L, Ang KL, et al. New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules. Eur J Cardiothorac Surg, 2017, 51(4): 689-693.
18. Licker MJ, Widikker I, Robert J, et al. Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg, 2006, 81(5): 1830-1837.
19. Lee JY, Jin SM, Lee CH, et al. Risk factors of postoperative pneumonia after lung cancer surgery. J Korean Med Sci, 2011, 26(8): 979-984.
20. Cerfolio RJ, Bryant AS. Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output. J Thorac Cardiovasc Surg, 2008, 135(2): 269-273.
21. 朱军伟, 李印. 肺部分切除术后胸腔引流管拔除时机的现状及进展. 中国微创外科杂志, 2015, 15(4): 373-375.
22. 杜娜, 饶志勇, 车国卫, 等. 肺癌术后短期中链甘油三酯饮食临床效果的前瞻性随机研究. 中国肺癌杂志, 2016, 19(12): 821-826.