老年肺癌患者行单孔胸腔镜下肺叶或肺段切除术后并发症危险因素分析

doi:10. 3969/ j. issn. 1006-7795. 2024. 01. 019

首都医科大学学报 ›› 2024, Vol. 45 ›› Issue (1): 118-126.doi: 10. 3969/ j. issn. 1006-7795. 2024. 01. 019

老年肺癌患者行单孔胸腔镜下肺叶或肺段切除术后并发症危险因素分析

田笑如，钱坤，张培龙，张毅^*

首都医科大学宣武医院胸外科，北京 100053

收稿日期:2023-06-08 出版日期:2024-02-21 发布日期:2024-03-22
通讯作者: 张毅 E-mail:zhangyixwhospp@xwh.ccmu.edu.cn
基金资助:
首都卫生发展科研专项（2022-2-2013）。

Analysis of risk factors for postoperative complications after uniportal-VATS lobectomy or segmentectomy in elderly patients with lung cancer

Tian Xiaoru， Qian Kun, Zhang Peilong, Zhang Yi^*

Department of Thoracic Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China

Received:2023-06-08 Online:2024-02-21 Published:2024-03-22
Supported by:
This study was supported by Capital Health Research and Development of Special Fund(2022-2-2013).

摘要/Abstract

摘要： 目的探讨老年肺癌患者行单孔胸腔镜下肺叶或肺段切除术后并发症发生的危险因素。方法纳入2020年1月至2021年12月首都医科大学宣武医院胸外科行单孔胸腔镜肺叶或肺段切除手术的≥60岁的387例老年肺癌患者作为研究对象，中位年龄67（60~87）岁，其中男性171例（44.2%），女性216例（55.8%）。对老年肺癌患者的术后并发症进行分析，评估老年肺癌患者行单孔胸腔镜肺段或肺叶切除术后并发症发生的危险因素。结果 387例患者中共有66例(17.1%)术后出现并发症，其中1例(0.3%)患者死亡。单因素及多因素分析显示：男性（P=0.020）、第1秒用力呼气容积（forced expiratory volume in the first second，FEV1）<1.5 L(P=0.017)、一氧化碳弥散量占预计值百分比（diffusion capacity of the lungs for carbon monoxide as a percentage of the predicted value，DLCO%pred）<80%(P=0.016)、伴有肺部合并症病史(P<0.001)、脑卒中病史(P<0.001) 、手术时长≥3 h（P=0.018）为术后出现并发症的独立预测因素。而伴有肺部合并症病史(P<0.001)及手术时长≥3 h(P=0.002)是术后出现肺部并发症的独立危险因素（P<0.05）。结论老年肺癌患者可能因肺部合并症、低肺功能、手术时间等出现术后并发症，因此术前应充分评估老年肺癌患者的生理情况。通过加强围术期管理降低术后并发症的发生率，降低术后并发症对老年肺癌患者行单孔胸腔镜手术治疗效果的影响。

关键词: 老年, 肺癌, 单孔胸腔镜, 术后并发症, 危险因素

Abstract: Objective To explore the risk factors of postoperative complications after uniportal-video-assisted thoracic surgery(VATS) lobectomy or segmentectomy in elderly patients with lung cancer. Methods Lung cancer patients aged 60 years or older who underwent radical lobectomy or segmentectomy by uniportal-VATS from January 2020 to December 2021 were retrospectively studied. Preoperative and postoperative clinical data,including age,gender,smoking index,preoperative comorbidities,respiratory function,Charlson Comorbidity Index,surgical procedure,operation time et al.were collected.Univariate and multivariate Logistic regression were used to analyze risk factors. Results A total of 387 patients,comprising 171 (44.2%) male and 216 (55.8%) female were enrolled. The median age was 67 (range 60-87)years. Postoperative complications were observed in 66 (17.1%) patients; postoperative mortalities occurred in 1(0.3%) patient. Univariate and multivariate analyses showed that male (P=0.020),forced expiratory volume in the first second(FEV1)<1.5L(P=0.017),diffusion capacity of the lungs for carbon monoxide as a percentage of the predicted value(DLCO%pred)<80%(P=0.016),preoperative pulmonary comorbidities(P<0.001),preoperative stroke(P<0.001) and operation time≥3 h(P=0.018) were associated with postoperative complications. And preoperative pulmonary comorbidities(P<0.001) and operation time≥3 h(P=0.002)were associated with postoperative pulmonary complications. Conclusion Elderly patients with lung cancer may have postoperative complications due to preoperative pulmonary comorbidities,poor lung function and longer operation time and so on. Therefore,the physiological status of elderly lung cancer patients should be fully evaluated preoperatively. By strengthening perioperative management,we may reduce the effect of postoperative complications on the treatment effect of uniportal-VATS surgery in elderly lung cancer patients.

Key words: elderly, lung cancer, uniportal-assisted thoracic surgery(VATS), postoperative complications, risk factors

中图分类号:

R734.2

田笑如, 钱坤, 张培龙, 张毅. 老年肺癌患者行单孔胸腔镜下肺叶或肺段切除术后并发症危险因素分析[J]. 首都医科大学学报, 2024, 45(1): 118-126.

Tian Xiaoru, Qian Kun, Zhang Peilong, Zhang Yi. Analysis of risk factors for postoperative complications after uniportal-VATS lobectomy or segmentectomy in elderly patients with lung cancer[J]. Journal of Capital Medical University, 2024, 45(1): 118-126.

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老年肺癌患者行单孔胸腔镜下肺叶或肺段切除术后并发症危险因素分析

Analysis of risk factors for postoperative complications after uniportal-VATS lobectomy or segmentectomy in elderly patients with lung cancer

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