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