肺上叶切除术后胸内残腔发生的危险因素及其对术后早期并发症的影响

doi:10.3969/j.issn.1000-6621.2018.12.008

摘要/Abstract

摘要：

目的探讨肺上叶切除术后胸内残腔发生的危险因素及其对术后早期并发症的影响。方法回顾性分析2014年10月至2017年10月武汉市肺科医院80例行肺上叶切除术患者的临床资料,包括原发肺恶性肿瘤者23例(28.75%),感染性肺病者57例(71.25%)。根据术后是否发生胸内残腔分为有残腔组(29例)和无残腔组(51例),比较两组相关因素的差异,分析胸内残腔发生的危险因素及其对患者术后早期并发症的影响。结果 80例肺上叶切除者中术后发生胸内残腔者29例,发生率为36.25%。有残腔组患者发生全胸膜粘连者占72.41%(21/29),明显高于无残腔组[27.45%(14/51)],差异有统计学意义(χ ²=15.19,P=0.001);有残腔组患者第1秒用力肺活量(FEV₁)<1.85L者占60.00%(12/20),明显高于无残腔组[16.67%(6/36)],差异有统计学意义(χ ²=11.07,P=0.001)。logistic回归分析显示,有全胸膜腔粘连者发生术后胸内残腔的风险是无全胸膜粘连者的7.00(1.66~29.46)倍;FEV₁<1.85L者发生术后胸内残腔的风险是FEV₁≥1.85L者的10.50(2.40~46.02)倍。术后有残腔组72h引流量中位数(四分位数)[M(Q₁,Q₃)]为1380(1010,1635)ml,明显多于无残腔组患者的920(630,1150)ml和,差异有统计学意义(U=351.00,P<0.05);术后有残腔组拔管时间M(Q₁,Q₃)为15.0(11.5,25.0)d,明显较无残腔组[9.0(7.0,10.0)d]延长,差异有统计学意义(U=215.50,P<0.05)。术后早期发生手术重大并发症者4例(5.00%),均为发生术后胸内残腔者;其中残腔感染3例,迟发性胸腔活动性出血1例。结论全胸膜腔粘连、FEV₁<1.85L是导致肺上叶切除术后胸内残腔发生的独立危险因素。术后胸内残腔在术后早期可导致胸腔渗液增多和拔管时间延长,并可继发残腔感染和迟发性胸腔出血等严重并发症。

关键词: 肺外科手术, 胸腔, 手术后并发症, 危险因素, 对比研究

Abstract:

Objective To analyze the risk factors of residual postoperative pleural space (RPPS) after superior lobectomy and its effect on postoperative complications.Methods A retrospective analysis was conducted on the clinical data of 80 patients who underwent superior lobectomy in Wuhan Pulmonary Hospital from October 2014 to October 2017, including 23 patients with primary pulmonary malignancies (28.75%) and 57 patients with pulmonary infectious diseases (71.25%). According to the occurrence of RPPS, they were divided into two groups: 29 cases with RPPS and 51 cases without RPPS. The differences in potential factors between the two groups were compared, and the risk factors of RPPS and its effect on early postoperative complications were analyzed.Results Of the 80 patients with superior lobectomy, 29 had RPPS, and the incidence was 36.25%. Total pleural adhesions were found in 72.41% (21/29) of patients with RPPS, significantly higher than those without RPPS (27.45% (14/51)), and the difference was statistically significant (χ ²=15.19, P=0.001). Forced expiratory volume in 1 second (FEV₁) <1.85L were found in 60.00% (12/20) of patients with RPPS, significantly higher than those without RPPS (16.67% (6/36)), and the difference was statistically significant (χ ²=11.07, P=0.001). Logistic regression analysis showed that the risk of RPPS in patients with total pleural adhesion was 7.00 (1.66-29.46) times that of patients without total pleural adhesion; the risk of RPPS in patients with FEV₁<1.85L was 10.50 (2.40-46.02) times that of patients with FEV₁≥1.85L. The postoperative 72-h drainage flow of RPPS group and non RPPS group (median (interquartile range)) (M(Q₁,Q₃)) was 1380 (1010-1635)ml and 920 (630-1150)ml, and there was statistically significant difference (U=351.00, P<0.05). The postoperative extubation time (M(Q₁,Q₃)) of the two groups was 15.0 (11.5, 25.0) and 9.0 (7.0, 10.0)days, respectively, and there was statistically significant difference (U=215.50, P<0.05). Four patients (5.00%) had serious complications in the early postoperative period. All of them occurred RPPS. RPPS infection was found in 3 patients and delayed bleeding in 1 patient. Conclusion The independent risk factors of RPPS include pleural adhesion and FEV₁<1.85L. RPPS could lead to increased drainage and prolonged extubation time in the early postoperative period, and serious complications such as infection and delayed bleeding can occur.

Key words: Pulmonary surgical procedures, Thoracic cavity, Postoperative complications, Risk factors, Comparative study

蒋钰辉,申磊,戴希勇. 肺上叶切除术后胸内残腔发生的危险因素及其对术后早期并发症的影响[J]. 中国防痨杂志, 2018, 40(12): 1280-1285. doi: 10.3969/j.issn.1000-6621.2018.12.008

JIANG Yu-hui,SHEN Lei,DAI Xi-yong.. Risk factors of residual postoperative pleural space after superior lobectomy and its effect on postoperative complications[J]. Chinese Journal of Antituberculosis, 2018, 40(12): 1280-1285. doi: 10.3969/j.issn.1000-6621.2018.12.008

图/表 2

表1

表2

肺上叶切除术术后发生胸内残腔危险因素的logistic回归分析

因素	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
有全胸膜腔粘连	2.56	0.92	7.78	0.008	7.00(1.66~29.46)
FEV₁<1.85L	2.39	0.93	6.66	0.002	10.50(2.40~46.02)

表2

参考文献 12

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影响因素	有残腔组(29例)	无残腔组(51例)	统计检验值	P值
年龄(岁)^a	55(48,59)	55(45,62)	U=723.00	0.869
性别[例(构成比,%)]			Fisher确切概率检验	0.740
男	26(89.66)	44(86.27)
女	3(10.34)	7(13.73)
吸烟史[例(构成比,%)]			χ²=1.18	0.278
有	14(48.28)	31(60.78)
无	15(51.72)	20(39.22)
手术部位[例(构成比,%)]			χ²=0.81	0.368
左上	9(31.03)	21(41.18)
右上	20(68.97)	30(58.82)
全胸膜腔粘连[例(构成比,%)]			χ²=15.19	0.001
有	21(72.41)	14(27.45)
无	8(27.59)	37(72.55)
原发病[例(构成比,%)]			χ²=7.52	0.006
肺恶性肿瘤	3(10.34)	20(39.22)
感染性肺病	26(89.66)	31(60.78)
手术方式[例(构成比,%)]			χ²=1.45	0.229
胸腔镜	7(24.14)	19(37.25)
常规开胸	22(75.86)	32(62.73)
基础肺部器质性疾病[例(构成比,%)]			χ²=10.61	0.001
是	27(93.10)	30(58.82)
否	2(6.90)	21(41.18)
手术时间(min)^a	310(200,375)	260(215,300)	U=544.00	0.048
FVC(L)^b	2.48±0.55	3.11±0.66	t=3.63	0.001
FEV₁(L)^b	1.85±0.44	2.41±0.50	t=4.15	0.001
FEV₁分级[例(构成比,%)]^c			χ²=11.07	0.001
<1.85L	12(60.00)	6(16.67)
≥1.85L	8(40.00)	30(83.33)
FEV₁/FVC(%)^b	74.67±11.74	76.34±9.75	t=0.57	0.570
MVV(%)^b	70.03±14.89	81.67±13.02	t=3.04	0.004

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