合并皮肌炎的非小细胞肺癌围手术期临床特点
|
摘要
目的分析胸腔镜肺叶切除治疗非小细胞肺癌(NSCLC)合并皮肌炎的围手术期临床特点。方法对6例合并皮肌炎的NSCLC患者和6例不伴皮肌炎的NSCLC患者进行1∶1配对研究,分别施行胸腔镜肺叶切除术治疗。对手术时间、术中失血量、术后肺炎/肺不张发生率、术后伤口恢复情况、术后3 d胸腔引流量、术后乳糜胸发生率、心律失常发生率、围手术期住院时间等进行比较。结果肺癌患者是否合并皮肌炎在手术时间、术中失血量、术后3 d胸腔引流量等方面比较,P>0.05,差异无统计学意义。合并皮肌炎与不伴皮肌炎患者的术后房颤发生率分别为50.00%(3/6)和16.66%(1/6),肺炎/肺不张发生率分别为50.00%(3/6)和16.66%(1/6),住院时间分别为(16.28±3.61)d和(11.11±2.92)d,差异有统计学意义(P<0.05)。结论合并皮肌炎的NSCLC患者肺叶切除术后房颤和肺炎/肺不张发生率较高,围手术期住院时间较长,应引起注意。
Objective To analyze the perioperative clinical characteristics of non-small cell lung cancer( NSCLC) complicated with dermatomyositis( DM). Methods Six cases of NSCLC complicated with DM received lobectomy and lymph node dissection by video-assisted thoracoscopic surgery. The same kind of operations were carried out in another six NSCLC cases without DM in the same period. The twelve cases in two groups were 1 ∶ 1 matched study. The operation time,operative blood loss,postoperative pneumonia or atelectasis rate,postoperative wound recovery,thoracic drainage in postoperative three days,incidence of postoperative atrial fibrillation,perioperative hospital stay were compared between the two groups. Results In operative time,blood loss and thoracic drainage volume in postoperative three days,there was no significant difference in two groups( P > 0. 05). In paients with and without DM,the occurrence rate of atrial fibrillation was respectively 50. 00%(3 /6) and 16. 66%(1 /6),the occurrence rate of postoperative pneumonia or atelectasis was respectively 50. 00%(3 /6) and 16. 66%(1 /6),and postoperative hospital stay was respectively(16. 28 ± 3. 61) d and(11. 11 ± 2. 92) d. It was of significant differences( P < 0. 05). Conclusion Compared with NSCLC patients without DM,postoperative atrial fibrillation and pneumonia or atelectasis occured more often in the DM cases. And patients with DM have longer hospital stays.
Objective To analyze the perioperative clinical characteristics of non-small cell lung cancer( NSCLC) complicated with dermatomyositis( DM). Methods Six cases of NSCLC complicated with DM received lobectomy and lymph node dissection by video-assisted thoracoscopic surgery. The same kind of operations were carried out in another six NSCLC cases without DM in the same period. The twelve cases in two groups were 1 ∶ 1 matched study. The operation time,operative blood loss,postoperative pneumonia or atelectasis rate,postoperative wound recovery,thoracic drainage in postoperative three days,incidence of postoperative atrial fibrillation,perioperative hospital stay were compared between the two groups. Results In operative time,blood loss and thoracic drainage volume in postoperative three days,there was no significant difference in two groups( P > 0. 05). In paients with and without DM,the occurrence rate of atrial fibrillation was respectively 50. 00%(3 /6) and 16. 66%(1 /6),the occurrence rate of postoperative pneumonia or atelectasis was respectively 50. 00%(3 /6) and 16. 66%(1 /6),and postoperative hospital stay was respectively(16. 28 ± 3. 61) d and(11. 11 ± 2. 92) d. It was of significant differences( P < 0. 05). Conclusion Compared with NSCLC patients without DM,postoperative atrial fibrillation and pneumonia or atelectasis occured more often in the DM cases. And patients with DM have longer hospital stays.
引文
[1]罗国军,张利,李卓东,等.外科治疗非小细胞肺癌280例临床分析[J].局解手术学杂志,2012,21(3):301-302.
[2]Bohan A,Peter JB.Polymyositis and dermatomyositis[J].N Engl J Med,1975,292(7):344-347.
[3]李运,王俊,隋锡朝,等.全胸腔镜肺叶切除手术操作流程及技巧的优化:北京大学人民医院经验[J].中华胸心血管外科杂志,2010,26(5):300-306.
[4]Wang J,Luke C,Tucker G,et al.The incidence and associations of malignancy in a large cohort of patients with biopsy-determined idiopathic inflammatory myositis[J].Rheumatol Int,2013,33(4):965-971.
[5]Zang YS,Xiu QY,Fang Z,et al.Case report:dramatic recovery of lung adenocarcinoma associated dermatomyositis with targeted lung cancer therapy alone[J].Oncologist,2008,13(1):79-81.
[6]Leow YH,Gol CL.Malignancy in adult dermatomyositis[J].Int J Dermatol,2007,36:904-907.
[7]Mitani K,Nishioka Y,Yamabe K,et al.Soluble Fas in malignant pleural effusion and its expression in lung cancer cells[J].Cancer Sci,2003,94(3):302-307.
[8]Mori H,Habe K,Hakamada A,et al.Relapse of dermatomyositis after 10years in remission following curative surgical treatment of lung cancer[J].J Dermatology,2005,32(4):290-294.
[9]Hemminki K,Liu X,Ji J,et al.Effect of autoimmune disease on risk and survival in histology-specific lung cancer[J].Eur Respir,2012,40(6):1489-1495.
[10]高茹,赵惠民,揭俊卿,等.肺癌合并皮肌炎3例的外科治疗[J].临床肺科杂志,2012,17(8):1540-1541.
[11]Bronner IM,van der Meulen MF,de Visser M,et al.Long term outcome in polymyositis and dermatomysitis[J].Ann Rheum Dis,2006,65(11):1456-1461.
[12]Yu KH,Wu YJ,Kuo CF,et al.Survival analysis of patients with dematomyositis and polymyositis:analysis of 190 chines cases[J].Clin Rheumatol,2011,30(12):1595-601.
[13]Li F,Zhang RQ,Jia GL,et al.Delayed energy metabolism improvement of ischemia-reperfusion myocardium induced by bradykinin in rabbits[J].Disi Junyi Daxue Xuebao(J Fourth Mil Med Univ),2001,22(21):1943-1945.
[14]Dominquez A,Allen MS,Cassivi SD,et al.Lung cancer in octogenarians:factors affecting morbidity and mortality after pulmonary resection[J].Ann Thorac Sur,2006,82(4):1175-1179.
[15]Tisdale JE,Wroblewski HA,Wall DS,et al.A randomized trial evaluating amiodarone for prevention of atrial fibrillation after pulmonary resection[J].Ann Thorac Surg,2009,88(3):886-895.
[16]Castro AS,Barroso A,Parente V,et al.Dermatomyositis as the first manifestation of lung tuomor[J].Rev Port Pneumol,2013,19(4):179-183.
[17]Won Huh J,Soon Kim D,Keun Lee C,et al.Two distinct clinical types of interstitial lung disease associated with polymyositis dermatomyositis[J].Respir Med,2007,101(8):1761-1769.
[18]Nigro E,Scudiero O,Sarnataro D,et al.Adiponectin affects lunge pithelial A549 cell viability counteracting TNF-αand IL-1βtoxicity through Adipo R1[J].Int J Biochem Cell Biol,2013,45(6):1145-53.
[19]朱旭利,廖康煌.17例中老年皮肌炎患者伴发恶性肿瘤的临床分析[J].现代实用医学,2011,23(4):374-375.
[2]Bohan A,Peter JB.Polymyositis and dermatomyositis[J].N Engl J Med,1975,292(7):344-347.
[3]李运,王俊,隋锡朝,等.全胸腔镜肺叶切除手术操作流程及技巧的优化:北京大学人民医院经验[J].中华胸心血管外科杂志,2010,26(5):300-306.
[4]Wang J,Luke C,Tucker G,et al.The incidence and associations of malignancy in a large cohort of patients with biopsy-determined idiopathic inflammatory myositis[J].Rheumatol Int,2013,33(4):965-971.
[5]Zang YS,Xiu QY,Fang Z,et al.Case report:dramatic recovery of lung adenocarcinoma associated dermatomyositis with targeted lung cancer therapy alone[J].Oncologist,2008,13(1):79-81.
[6]Leow YH,Gol CL.Malignancy in adult dermatomyositis[J].Int J Dermatol,2007,36:904-907.
[7]Mitani K,Nishioka Y,Yamabe K,et al.Soluble Fas in malignant pleural effusion and its expression in lung cancer cells[J].Cancer Sci,2003,94(3):302-307.
[8]Mori H,Habe K,Hakamada A,et al.Relapse of dermatomyositis after 10years in remission following curative surgical treatment of lung cancer[J].J Dermatology,2005,32(4):290-294.
[9]Hemminki K,Liu X,Ji J,et al.Effect of autoimmune disease on risk and survival in histology-specific lung cancer[J].Eur Respir,2012,40(6):1489-1495.
[10]高茹,赵惠民,揭俊卿,等.肺癌合并皮肌炎3例的外科治疗[J].临床肺科杂志,2012,17(8):1540-1541.
[11]Bronner IM,van der Meulen MF,de Visser M,et al.Long term outcome in polymyositis and dermatomysitis[J].Ann Rheum Dis,2006,65(11):1456-1461.
[12]Yu KH,Wu YJ,Kuo CF,et al.Survival analysis of patients with dematomyositis and polymyositis:analysis of 190 chines cases[J].Clin Rheumatol,2011,30(12):1595-601.
[13]Li F,Zhang RQ,Jia GL,et al.Delayed energy metabolism improvement of ischemia-reperfusion myocardium induced by bradykinin in rabbits[J].Disi Junyi Daxue Xuebao(J Fourth Mil Med Univ),2001,22(21):1943-1945.
[14]Dominquez A,Allen MS,Cassivi SD,et al.Lung cancer in octogenarians:factors affecting morbidity and mortality after pulmonary resection[J].Ann Thorac Sur,2006,82(4):1175-1179.
[15]Tisdale JE,Wroblewski HA,Wall DS,et al.A randomized trial evaluating amiodarone for prevention of atrial fibrillation after pulmonary resection[J].Ann Thorac Surg,2009,88(3):886-895.
[16]Castro AS,Barroso A,Parente V,et al.Dermatomyositis as the first manifestation of lung tuomor[J].Rev Port Pneumol,2013,19(4):179-183.
[17]Won Huh J,Soon Kim D,Keun Lee C,et al.Two distinct clinical types of interstitial lung disease associated with polymyositis dermatomyositis[J].Respir Med,2007,101(8):1761-1769.
[18]Nigro E,Scudiero O,Sarnataro D,et al.Adiponectin affects lunge pithelial A549 cell viability counteracting TNF-αand IL-1βtoxicity through Adipo R1[J].Int J Biochem Cell Biol,2013,45(6):1145-53.
[19]朱旭利,廖康煌.17例中老年皮肌炎患者伴发恶性肿瘤的临床分析[J].现代实用医学,2011,23(4):374-375.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |