网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
Ⅰ期老年非小细胞肺癌患者胸腔镜术后主要并发症影响因素的分析及预测模型的构建
作者:杨星星  朱艳霞  刘琴  程帆  司小敏 
单位:十堰市太和医院 心肺康复中心, 湖北 十堰 442000
关键词:非小细胞肺癌 胸腔镜 术后主要并发症 危险因素 预测模型 
分类号:R734.2;R655
出版年·卷·期(页码):2021·49·第一期(69-74)
摘要:

目的: 研究影响Ⅰ期老年非小细胞肺癌患者胸腔镜术(VATS)后发生主要并发症的危险因素及预测模型的构建。方法: 选取2012年2月至2019年3月在本院胸外科行VATS的806例Ⅰ期老年非小细胞肺癌患者,根据是否发生主要并发症分为主要并发症组(n=51)和无主要并发症组(n=755)。分析两组患者并发症发生情况和临床资料。采用单因素分析比较两组患者年龄、性别、吸烟史、肺部感染、合并症、肺功能、病理类型等,对有差异的因素进行Logistic多因素分析,建立主要并发症的全变量风险预测模型,并通过ROC曲线验证预测有效性。结果: 51例出现主要并发症的患者中,以肺部和心脑血管并发症为主。单因素分析显示,性别(χ2=10.861,P=0.001)、吸烟史(χ2=4.351,P=0.037)、肺部感染(χ2=7.992,P=0.005)、合并症(χ2=22.909,P<0.001)、FEV1(t=3.334,P=0.013)、FEV1%(t=5.599,P<0.001)、手术持续时间(t=6.687,P=0.007)、出血量(t=5.990,P=0.024)是影响老年非小细胞肺癌患者行VATS后发生主要并发症的影响因素。多因素分析显示,肺部感染(OR=4.302,95%CI:3.670~5.042)、合并症(OR=1.863,95%CI:1.348~2.574)、手术时间(OR=5.546,95%CI:4.332~7.099)、出血量(OR=6.098,95%CI:3.908~9.515)是影响老年非小细胞肺癌患者VATS后主要并发症发生的独立危险因素。用Enter法建立主要并发症临床预测模型为:P=1/(1+e-y),y=-3.140+1.459×肺部感染+0.622×合并症+1.713×手术时间+1.909×出血量。ROC曲线下面积为0.973,95%CI为0.948~0.997,灵敏度为82.0%,特异度为84.2%。结论: 肺部感染、合并症、手术时间、出血量是影响Ⅰ期老年非小细胞肺癌患者VATS后发生主要并发症的独立危险因素,这四者联合能较好地预测主要并发症的发生。

Objective: By analyzing the clinical data of patients with stage I non-small-cell lung cancer (NSCLC) under treatment of video-assisted thoracic surgery (VATS), this study aims to explore the predict value and impacts of the major complications. Methods: A total of 806 patients diagnosed as stage Ⅰ NSCLC and received VATS were enrolled from February 2012 to March 2019 in our hospital. Patients were divided into major complications group (n=51) and non-major-complications group (n=755). Comparing the clinical data between the patients in the two groups, such as age, gender, smoking, pulmonary infection and pulmonary functions by single factor analysis. The multi-factor analysis was performed to explore the risk factors and prediction model of major complications.Results: The primary complications were pulmonary and cardiovascular complications. Gender (χ2=10.861,P=0.001), smoking(χ2=4.351,P=0.037), lung infection before operation (χ2=7.992,P=0.005), complications before operation (χ2=22.909,P<0.001), FEV1(t=3.334, P=0.013), FEV1%(t=5.599, P<0.001), operation time (t=6.687, P=0.007), blood loss(t=5.990, P=0.024) showed significantly differences between the two groups. The multi-factor analysis showed that lung infection before operation(OR=4.302, 95%CI:3.670-5.042), complications before operation(OR=1.863, 95%CI:1.348-2.574), operation time (OR=5.546, 95%CI:4.332-7.099), blood loss (OR=6.098, 95%CI:3.908-9.515)were the independent risk factors of major complications after VATS. The prediction model acquired using the Enter for major complications was P=1/(1+e-y),y=-3.140+1.459×lung infection before operation+0.622×complications before operation+1.713×operation time+1.909×blood looss. The area under ROC curve was 0.973, with the 95%CI being 0.948-0.997, sensitivity being 82.0%, specificity being 84.2%. Conclusion: Lung infection before operation, complications before operation, operation time, blood loss were the independent risk factors of major complications after VATS in elderly patients with stage Ⅰ NSCLC. These factors have the potential to predict major complications.

参考文献:

[1] WANG S,LI X,LI Y,et al.The long-term impact of postoperative pulmonary complications after video-assisted thoracic surgery lobectomy for lung cancer[J].J Thorac Dis,2017,9(12):5143-5152.
[2] 李鹏飞,赖玉田,周坤,等.应用Clavien-Dindo分级系统对肺癌患者术后并发症分级及危险因素分析[J].中国肺癌杂志,2017,20(4):264-271.
[3] 王少东,隋锡朝,杨帆,等.早期非小细胞肺癌VATS根治术并发症预测模型的建立——前瞻性多中心研究[J].中华胸心血管外科杂志,2017,33(2):87-90.
[4] DINDO D,DEMARTINES N,CLAVIEN P A.Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J].Ann Surg,2004,240(2):205-213.
[5] 马艺洪,周建明,薛涛.胸腔镜肺癌术后急性肺动脉栓塞两例的临床分析[J].东南大学学报(医学版),2018,37(6):143-145.
[6] AGOSTINI P J,LUGG S T,ADAMS K,et al.Risk factors and short-term outcomes of postoperative pulmonary complications after VATS lobectomy[J].J Cardiothorac Surg,2018,13(1):28-35.
[7] SAITO H,HATAKEYAMA K,KOMMO H,et al.Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease[J].Thorac Cancer,2017,8(5):451-460.
[8] LI X,LI S,YAN S,et al.Impact of preoperative exercise therapy on surgical outcomes in lung cancer patients with or without COPD:a systematic review and meta-analysis[J].Cancer Manag Res,2019,11:1765-1777.
[9] JING R,HE S,DAI H,et al.Incidence and risk factors of postoperative pulmonary complications after thoracic surgery for early non-small cell lung cancer[J].Int J Clin Exp Med,2018,11(1):285-294.
[10] PEI G,ZHOU S,HAN Y,et al.Risk factors for postoperative complications after lung resection for non-small cell lung cancer in elderly patients at a single institution in China[J].J Thorac Dis,2014,6(9):1230-1238.
[11] NAGASHIMA T,ITO H,YAGASAKI H,et al.Analysis of pre and intra operative factors related to the operation time of lobectomy in VATS:is the shape of thoracic cavity a predictive factor?[J].J Thorac Oncol,2018,13(10):S845.
[12] COHEN E,SLINGER P.Anesthesia for video-assisted thoracoscopic surgery (VATS)[M]//Principles and practice of anesthesia for thoracic surgery.Cham:Springer, 2019:413-424.
[13] LI S,ZHOU K,LAI Y,et al.Estimated intraoperative blood loss correlates with postoperative cardiopulmonary complications and length of stay in patients undergoing video-assisted thoracoscopic lung cancer lobectomy:a retrospective cohort study[J].BMC Surg,2018,18(1):29-40.
[14] RAHOUMA M,KAMEL M,GHALY G,et al.PUB010 intrao-perative blood loss is an independent predictor of poor disease free survival for patients undergoing VATS lobectomy for lung cancer[J].J Thorac Oncol,2017,12(1):S1451-S1452.
[15] LUGG S T,TIKKA T,AGOSTINI P J,et al.Smoking and ti ming of cessation on postoperative pulmonary complications after curative-intent lung cancer surgery[J].J Cardiothorac Surg,2017,12(1):52-59.
[16] D'ANDRILI A,RENDINA E A.Enhanced recovery after surgery (ERAS) and fast-track in video-assisted thoracic surgery (VATS) lobectomy:preoperative optimisation and care-plans[J].J Vis Surg,2018,4(1):4-9.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 499968 位访问者


 ©《现代医学》编辑部
联系电话:025-83272481;83272479
电子邮件: xdyx@pub.seu.edu.cn

苏ICP备09058541