食管癌患者术后肺部并发症危险因素分析
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摘要
目的探讨食管癌患者术后出现肺部并发症的危险因素,为临床治疗及预防提供参考。方法回顾性分析中国人民解放军第八一医院2015年12月至2017年12月200例行食管癌切除术患者的临床及随访资料,分析其术后肺部并发症特征,采用Logistic回归分析探讨导致食管癌患者术后肺部并发症的危险因素。结果本研究200例患者中术后出现肺部并发症24例,发生率为12.00%,其中肺部感染21例、肺不张10例、急性呼吸窘迫综合征2例、呼吸衰竭2例、肺水肿2例、肺栓塞2例,其中14例患者合并2种或2种以上肺部并发症,无死亡患者。单因素分析显示,食管癌患者术后出现肺部并发症与年龄、肥胖、低蛋白血症、吸烟、糖尿病、心血管疾病、肺部疾病、术前肺功能、肿瘤位置有关(P_均<0.05),与性别、贫血、饮酒、病理分期无关(P_均>0.05);将单因素分析中有统计学意义的变量作为自变量进行二分类Logistic逐步回归分析,结果显示:高龄、合并肺部疾病、术前肺功能较差、肿瘤位于上、中段是导致食管癌患者术后发生肺部并发症的独立危险因素[OR=2.349(1.368~4.035),OR=2.212(1.123~4.359),OR=2.115(1.212~3.690),OR=2.257(1.220~4.176)]。结论导致食管癌患者术后出现肺部并发症的独立危险因素包括高龄、合并肺部疾病、术前肺功能较差、肿瘤位于上、中段,临床应针对上述危险因素采取对应的预防措施,以减少术后并发症的发生,改善患者预后。
Objective To investigate the risk factors of pulmonary complications in patients with esophageal carcinoma after esophagectomy to provide the reference for taking effective prevention and control measures. Method Retrospectively analyzed the the clinical and follow-up data of 200 patients with esophageal cancer who underwent esophagectomy from December 2015 to December 2017 in 81 Hospital of PLA, the features of postoperative pulmonary complications were investigated. The clinical risk factors for pulmonary complications in patients with esophageal carcinoma after esophagectomy were investigated by the Logistic regression analysis. Result There were 24 cases with postoperative pulmonary complications in the 200 patients enrolled, with a rate of 12.00%. The pulmonary complications included 21 cases of pulmonary infection, 10 cases of atelectasis, 2 cases of acute respiratory distress syndrome, 2 cases of respiratory failure, 2 cases of pulmonary edema and 2 cases of pulmonary embolism, of which 14 cases combined with 2 or more than 2 kinds of pulmonary complications, and no patients died. The results of single factor analysis showed that and the age, obesity, hypoproteinemia, smoking, diabetes, cardiovascular disease, lung disease, preoperative pulmonary function and tumor location were the risk factors for postoperative pulmonary complications in patients with esophageal cancer after esophagectomy(P_(all)< 0.05), and sex, alcohol intake, anemia, pathology staging were no correlated with the pulmonary complications(P_(all)> 0.05). The results of stepwise Logistic regression analysis showed that the elderly, combined with pulmonary disease, poor preoperative pulmonary function, the tumor was located in the upper/middle segment were independent risk factors for pulmonary complications in patients with esophageal cancer after esophagectomy [OR = 2.349(1.368 ~ 4.035), OR = 2.212(1.123 ~ 4.359), OR = 2.115(1.212 ~ 3.690), OR = 2.257(1.220 ~ 4.176)]. Conclusion The risk factors of pulmonary complications in patients with esophageal cancer after esophagectomy including elderly, combined with pulmonary disease, poor preoperative pulmonary function, the tumor is located in the upper/middle segment. In order to reduce the incidence of postoperative complications and improve the prognosis of patients, corresponding preventive measures should be taken according to the above risk factors.
Objective To investigate the risk factors of pulmonary complications in patients with esophageal carcinoma after esophagectomy to provide the reference for taking effective prevention and control measures. Method Retrospectively analyzed the the clinical and follow-up data of 200 patients with esophageal cancer who underwent esophagectomy from December 2015 to December 2017 in 81 Hospital of PLA, the features of postoperative pulmonary complications were investigated. The clinical risk factors for pulmonary complications in patients with esophageal carcinoma after esophagectomy were investigated by the Logistic regression analysis. Result There were 24 cases with postoperative pulmonary complications in the 200 patients enrolled, with a rate of 12.00%. The pulmonary complications included 21 cases of pulmonary infection, 10 cases of atelectasis, 2 cases of acute respiratory distress syndrome, 2 cases of respiratory failure, 2 cases of pulmonary edema and 2 cases of pulmonary embolism, of which 14 cases combined with 2 or more than 2 kinds of pulmonary complications, and no patients died. The results of single factor analysis showed that and the age, obesity, hypoproteinemia, smoking, diabetes, cardiovascular disease, lung disease, preoperative pulmonary function and tumor location were the risk factors for postoperative pulmonary complications in patients with esophageal cancer after esophagectomy(P_(all)< 0.05), and sex, alcohol intake, anemia, pathology staging were no correlated with the pulmonary complications(P_(all)> 0.05). The results of stepwise Logistic regression analysis showed that the elderly, combined with pulmonary disease, poor preoperative pulmonary function, the tumor was located in the upper/middle segment were independent risk factors for pulmonary complications in patients with esophageal cancer after esophagectomy [OR = 2.349(1.368 ~ 4.035), OR = 2.212(1.123 ~ 4.359), OR = 2.115(1.212 ~ 3.690), OR = 2.257(1.220 ~ 4.176)]. Conclusion The risk factors of pulmonary complications in patients with esophageal cancer after esophagectomy including elderly, combined with pulmonary disease, poor preoperative pulmonary function, the tumor is located in the upper/middle segment. In order to reduce the incidence of postoperative complications and improve the prognosis of patients, corresponding preventive measures should be taken according to the above risk factors.
引文
[1]曹小琴,孙喜斌.食管癌发病水平及变化趋势[J].中国肿瘤临床,2016,43(21):932-936.
[2]Rubenstein JH,Shaheen NJ.Epidemiology,Diagnosis,and Management of Esophageal Adenocarcinoma[J].Gastroenterology,2015,149(2):302.
[3]Jafari M,Moradi Y,Khodadost M,et al.Trend of the Esophageal Cancer Incidence in IRAN[J].Emergency Medicine Journal,2015,23(3):163-168.
[4]傅剑华,谭子辉.食管癌外科治疗的现状与未来展望[J].中国肿瘤临床,2016,43(12):507-510.
[5]刘娟,李新红,秦燕,等.奈达铂联合替加氟治疗中晚期食管癌的临床观察[J].中国肿瘤临床与康复,2016,23(4):430-433.
[6]王宇飞,郭占林.食管癌术后并发症发生的危险因素分析[J].内蒙古医科大学学报,2015,57(6):572-575.
[7]杨泽山.431例老年食管癌患者术后肺部并发症情况及危险因素分析[J].中华全科医学,2015,13(11):1779-1781.
[8]岳泓旭,徐新建,李飞,等.新辅助放化疗联合手术治疗老年晚期食管癌患者的安全性及远期疗效分析[J].实用癌症杂志,2016,31(4):595-597.
[9]李晓雷,徐俊,梁青松,等.胸腔镜食管癌根治术的临床效果及术后并发症观察[J].中国现代手术学杂志,2017,21(1):27-30.
[10]李新选,杨斌.左胸微创切口手术在老年食管癌的应用效果观察[J].解放军医药杂志,2016,28(4):40-42.
[11]孙超,周路琦,邵雪斋,等.低蛋白血症对食管癌术后并发症的影响[J].河北医学,2015,21(4):570-573.
[12]张华.不同麻醉方法对老年食管癌患者术后肺部感染的影响[J].中国医学前沿杂志(电子版),2014,6(6):167-169.
[13]吴伟,王可兵,史冬森,等.食管癌术后肺部并发症的患者相关危险因素分析[J].临床肺科杂志,2015,20(7):1186-1188.
[14]高晓,田伟,田延龙.食管癌病理特点及治疗预后的影响因素研究[J].中国医刊,2017,52(2):45-52.
[15]段晓峰,弓磊,尚晓滨,等.食管鳞癌患者术前空腹血糖水平与术后并发症的相关性研究[J].中华胃肠外科杂志,2016,19(9):1004-1008.
[16]崔文峰,曹纪伟,巴玉峰.胸腹腔镜食管癌根治术对老年食管癌患者肺功能及炎症因子的影响[J].肿瘤学杂志,2017,23(9):823-826.
[17]高雅虹,汤哲,孙菲,等.北京地区老年人肺功能现状评估与分析[J].中华老年医学杂志,2017,36(1):88-92.
[18]岳侃,岳国强,孙永辉.全腔镜下食管癌根治术围术期呼吸系统并发症原因分析及预防[J].临床误诊误治,2016,29(3):2176-2178.
[19]巨亚丽,王秀娟,胡亚会,等.围术期舒适护理对老年食管癌患者术后并发症及护理满意度的影响[J].中国肿瘤临床与康复,2015,22(7):852-854.
[20]王希文,任开明,刘海君.364例食管癌根治术后并发症的危险因素分析[J].临床外科杂志,2017,25(2):135-138.
[2]Rubenstein JH,Shaheen NJ.Epidemiology,Diagnosis,and Management of Esophageal Adenocarcinoma[J].Gastroenterology,2015,149(2):302.
[3]Jafari M,Moradi Y,Khodadost M,et al.Trend of the Esophageal Cancer Incidence in IRAN[J].Emergency Medicine Journal,2015,23(3):163-168.
[4]傅剑华,谭子辉.食管癌外科治疗的现状与未来展望[J].中国肿瘤临床,2016,43(12):507-510.
[5]刘娟,李新红,秦燕,等.奈达铂联合替加氟治疗中晚期食管癌的临床观察[J].中国肿瘤临床与康复,2016,23(4):430-433.
[6]王宇飞,郭占林.食管癌术后并发症发生的危险因素分析[J].内蒙古医科大学学报,2015,57(6):572-575.
[7]杨泽山.431例老年食管癌患者术后肺部并发症情况及危险因素分析[J].中华全科医学,2015,13(11):1779-1781.
[8]岳泓旭,徐新建,李飞,等.新辅助放化疗联合手术治疗老年晚期食管癌患者的安全性及远期疗效分析[J].实用癌症杂志,2016,31(4):595-597.
[9]李晓雷,徐俊,梁青松,等.胸腔镜食管癌根治术的临床效果及术后并发症观察[J].中国现代手术学杂志,2017,21(1):27-30.
[10]李新选,杨斌.左胸微创切口手术在老年食管癌的应用效果观察[J].解放军医药杂志,2016,28(4):40-42.
[11]孙超,周路琦,邵雪斋,等.低蛋白血症对食管癌术后并发症的影响[J].河北医学,2015,21(4):570-573.
[12]张华.不同麻醉方法对老年食管癌患者术后肺部感染的影响[J].中国医学前沿杂志(电子版),2014,6(6):167-169.
[13]吴伟,王可兵,史冬森,等.食管癌术后肺部并发症的患者相关危险因素分析[J].临床肺科杂志,2015,20(7):1186-1188.
[14]高晓,田伟,田延龙.食管癌病理特点及治疗预后的影响因素研究[J].中国医刊,2017,52(2):45-52.
[15]段晓峰,弓磊,尚晓滨,等.食管鳞癌患者术前空腹血糖水平与术后并发症的相关性研究[J].中华胃肠外科杂志,2016,19(9):1004-1008.
[16]崔文峰,曹纪伟,巴玉峰.胸腹腔镜食管癌根治术对老年食管癌患者肺功能及炎症因子的影响[J].肿瘤学杂志,2017,23(9):823-826.
[17]高雅虹,汤哲,孙菲,等.北京地区老年人肺功能现状评估与分析[J].中华老年医学杂志,2017,36(1):88-92.
[18]岳侃,岳国强,孙永辉.全腔镜下食管癌根治术围术期呼吸系统并发症原因分析及预防[J].临床误诊误治,2016,29(3):2176-2178.
[19]巨亚丽,王秀娟,胡亚会,等.围术期舒适护理对老年食管癌患者术后并发症及护理满意度的影响[J].中国肿瘤临床与康复,2015,22(7):852-854.
[20]王希文,任开明,刘海君.364例食管癌根治术后并发症的危险因素分析[J].临床外科杂志,2017,25(2):135-138.