Risk factors of residual postoperative pleural space after superior lobectomy and its effect on postoperative complications

doi:10.3969/j.issn.1000-6621.2018.12.008

Abstract

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

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

Figures/Tables 2

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)

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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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