青少年原发性自发性气胸患者胸腔镜术后复发的危险因素分析
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摘要
目的分析青少年原发性自发性气胸(PSP)患者胸腔镜术后复发的危险因素,为PSP术后预防复发提供依据。方法纳入对象为2010年11月至2016年1月北京友谊医院平谷医院胸外科收治的236例PSP患者,随访24个月,记录术后复发情况。将复发患者设为观察组,未复发患者设为对照组,收集所有患者病历资料,探讨性别、年龄、住院时间等对PSP复发的影响,并通过单因素与logistic回归分析探讨PSP患者胸腔镜术后复发的独立危险因素。结果 236例患者术后24个月内复发28例,复发率11. 86%,左侧16例,右侧12例,复发时间为(8. 56±2. 12)个月,复发年龄(24. 34±3. 54)岁。2组患者身体质量指数(BMI)、胸膜固定术、性别、术后吸烟、术前PSP发作次数、术后漏气时间、胸管维持时间对患者术后复发的影响差异具有统计学意义(P <0. 05);而年龄、发病部位、住院时间、手术时间、胸膜固定方法对患者术后复发的影响差异无统计学意义(P> 0. 05)。多因素logistic回归分析结果显示术前PSP发作次数大于等于3次(OR=2. 543,95%CI:0. 765～6. 646)、术后吸烟(OR=2. 764,95%CI:1. 032～7. 521)、BMI <18. 5 kg/m~2(OR=2. 214,95%CI:1. 211～9. 623)、未进行胸膜固定术(OR=2. 486,95%CI:1. 186～7. 326)是PSP患者胸腔镜术后复发的独立危险因素。结论 PSP发作次数大于等于3次、术后吸烟、BMI <18. 5 kg/m~2、未进行胸膜固定术均会增加PSP患者胸腔镜术后复发风险。
Objective To investigate the risk factors of recurrence after adolescent pimary spontaneous pneumothorax( PSP) thoracicassisted surgery,and to provide a theoretical basis for the prevention of the PSP recurrence. Methods A total of 236 patients with PSP admitted into thoracic surgery department of Pinggu hospital of Beijing friendship hospital from November 2010 to January 2016 were selected.All patients were followed up for 24 months,the recurrence rate was recorded. Recurrence patients were included into observation group,nonrelapse patients were enrolled into the control group. All patients' medical records were collected to study the influence of gender,age,length of stay on the recurrence of PSP. Then the independent risk factors for PSP recurrence after thoracoscopic surgery were analyzed by single factor and logistic regression analysis. Results During the follow-up of 24 months,the recurrence rate was 11. 86%( 28 cases) among 236 patients,with 16 cases on the left side and 12 cases on the right side; the recurrence time was( 8. 56 ± 2. 12) months,and the mean age was( 24. 34 ± 3. 54) years old. Body mass index( BMI),pleurodesis,gender,postoperative smoking,number of preoperative PSP episodes,postoperative leak time,and thoracic tube drainage time were significantly different between two groups( P < 0. 05),while no difference was found in the age,incidence site,length of stay,operation time,pleura fixation between two groups( P > 0. 05). Multivariate logistic regression analysis showed that preoperative PSP episodes ≥3 times( OR = 2. 543,95% CI: 0. 765 ～ 6. 646),postoperative smoking( OR = 2. 764,95% CI:1. 032 ～ 7. 521),BMI < 18. 5 kg/m~2( OR = 2. 214,95% CI: 1. 211 ～ 9. 623),without pleurodesis( OR = 2. 486,95% CI: 1. 186 ～ 7. 326)were independent risk factors for PSP recurrence after thoracoscopic surgery. Conclusion PSP episodes ≥3 times,postoperative smoking,BMI < 18. 5 kg/m~2,without pleurodesis may increase the risk of PSP recurrence after thoracoscopic surgery.
Objective To investigate the risk factors of recurrence after adolescent pimary spontaneous pneumothorax( PSP) thoracicassisted surgery,and to provide a theoretical basis for the prevention of the PSP recurrence. Methods A total of 236 patients with PSP admitted into thoracic surgery department of Pinggu hospital of Beijing friendship hospital from November 2010 to January 2016 were selected.All patients were followed up for 24 months,the recurrence rate was recorded. Recurrence patients were included into observation group,nonrelapse patients were enrolled into the control group. All patients' medical records were collected to study the influence of gender,age,length of stay on the recurrence of PSP. Then the independent risk factors for PSP recurrence after thoracoscopic surgery were analyzed by single factor and logistic regression analysis. Results During the follow-up of 24 months,the recurrence rate was 11. 86%( 28 cases) among 236 patients,with 16 cases on the left side and 12 cases on the right side; the recurrence time was( 8. 56 ± 2. 12) months,and the mean age was( 24. 34 ± 3. 54) years old. Body mass index( BMI),pleurodesis,gender,postoperative smoking,number of preoperative PSP episodes,postoperative leak time,and thoracic tube drainage time were significantly different between two groups( P < 0. 05),while no difference was found in the age,incidence site,length of stay,operation time,pleura fixation between two groups( P > 0. 05). Multivariate logistic regression analysis showed that preoperative PSP episodes ≥3 times( OR = 2. 543,95% CI: 0. 765 ～ 6. 646),postoperative smoking( OR = 2. 764,95% CI:1. 032 ～ 7. 521),BMI < 18. 5 kg/m~2( OR = 2. 214,95% CI: 1. 211 ～ 9. 623),without pleurodesis( OR = 2. 486,95% CI: 1. 186 ～ 7. 326)were independent risk factors for PSP recurrence after thoracoscopic surgery. Conclusion PSP episodes ≥3 times,postoperative smoking,BMI < 18. 5 kg/m~2,without pleurodesis may increase the risk of PSP recurrence after thoracoscopic surgery.
引文
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[2]李勃,徐飞,刘文,等.首次发作特发性自发性气胸手术指征的探讨[J].中国医师杂志,2015,17(1):110-111.
[3]吴功志,吴旭辉,彭丛兄,等.自发性气胸采用胸腔镜治疗对控制术后肺部感染及远期复发的临床研究[J].中华医院感染学杂志,2017,27(4):861-863.
[4]中华医学会.临床诊疗指南.呼吸病学分册[M].北京:人民卫生出版社,2012:152-156.
[5]Huang H,Ji H,Tian H.Risk factors for recurrence of primary spontaneous pneumothorax after thoracoscopic surgery[J].Biosci Trends,2015,9(3):193.doi:10.5582/bst.2015.01070.
[6]Nakayama T,Takahashi Y,Uehara H,et al.Outcome and risk factors of recurrence after thoracoscopic bullectomy in young adults with primary spontaneous pneumothorax[J].Surg Today,2016,47(7):1-6.doi:10.1007/s00595-016-1452-z.
[7]朱建福,何爱敏,黄兵,等.电视胸腔镜手术与开胸手术治疗自发性气胸的对比分析[J].徐州医学院学报,2016,36(11):757-759.doi:10.3969/j.issn.1000-2065.2016.11.016.
[8]Huang YF,Chiu WC,Chou SH,et al.Association of MMP-2 and MMP-9expression with recurrences in primary spontaneous pneumothorax[J].Kaohsiung J Med Sci,2017,33(1):17-23.doi:10.1016/j.kjms.2016.10.007.
[9]Bintcliffe OJ,Hallifax RJ,Edey A,et al.Spontaneous pneumothorax:time to rethink management?[J].Lancet Respir Med,2015,3(7):578-588.doi:10.1016/S2213-2600(15)00220-9.
[10]江吕泉,许为民,潘昱辰,等.不同年龄人群单中心自发性气胸的诊治[J].武警医学,2016,27(5):440-443.doi:10.3969/j.issn.1004-3594.2016.05.003.
[11]石珍亮,张逊,李月川.单中心1128例原发自发性气胸术后复发危险因素分析[J].天津医药,2017,45(4):381-384.
[12]谭军涛,张剑锋,曾光,等.原发性自发性气胸治疗后复发的多因素分析[J].广西医科大学学报,2016,33(1):63-65.
[13]龚立宏,王有钰,罗伟彬,等.胸腔镜手术治疗自发性气胸术后选择性不留置胸腔闭式引流8例报告[J].中国微创外科杂志,2016,16(8):761-762.doi:10.3969/j.issn.1009-6604.2016.08.024.
[14]侍管,崔永,常栋.首次发作的原发性自发性气胸复发因素研究进展[J].临床肺科杂志,2016,21(9):1693-1695.doi:10.3969/j.issn.1009-6663.2016.09.040.
[15]Mo A,Luo Y,Yang X,et al.Low-cost biportal endoscopic surgery for primary spontaneous pneumothorax[J].J Thorac Dis,2015,7(4):704-710.doi:10.3978/j.issn.2072-1439.2015.04.25.
[16]朱小东,曹和涛,苏海兵,等.原发性自发性气胸多层螺旋CT扫描胸部影像特征分析[J].临床放射学杂志,2017,36(9):1248-1252.
[17]杨震,闫天生,贺未.自发性气胸电视胸腔镜术后复发的相关预后因素研究现状[J].中国微创外科杂志,2017,17(5):461-465.doi:10.3969/j.issn.1009-6604.2017.05.020.
[18]沈明敬,徐中华,徐忠恒,等.单孔腔镜手术治疗单侧自发性气胸伴双肺大疱55例报告[J].中国微创外科杂志,2016,16(11):1016-1018.doi:10.3969/j.issn.1009-6604.2016.11.016.
[19]崔健,李钟,何江,等.经乳晕单切口胸腔镜治疗男性自发性气胸[J].中国微创外科杂志,2016,16(3):274-275.doi:10.3969/j.issn.1009-6604.2016.03.022.
[20]秦中华,黄斌.家族性自发性气胸4例分析并文献复习[J].安徽医学,2016,37(9):1139-1140.doi:10.3969/j.issn.1000-0399.2016.09.025.
[21]黄娜,方恩容,任柏沉,等.医用明胶海绵治疗难治性自发性气胸1例报告[J].临床肺科杂志,2017,22(1):183-185.doi:10.3969/j.issn.1009-6663.2017.01.055.
[22]幸华杰,刘彦国,王俊.家族性自发性气胸的研究进展[J].中华胸心血管外科杂志,2017,33(2):123-125.doi:10.3760/cma.j.issn.1001-4497.2017.02.018.
[23]张晶,雷军荣,罗国仕,等.内科胸腔镜在自发性气胸中的应用[J].临床肺科杂志,2017,22(1):69-72.doi:10.3969/j.issn.1009-6663.2017.01.020.
[24]王朝,邹卫,易龙,等.孪生兄弟肺大疱自发性气胸2例[J].中华胸心血管外科杂志,2016,32(6):368-369.doi:10.3760/cma.j.issn.1001-4497.2016.06.018.
[25]朱祥,郭依丹,王蓓娟,等.肺癌并自发性气胸二例并文献复习[J].实用心脑肺血管病杂志,2016,24(2):119-120.doi:10.3969/j.issn.1008-5971.2016.02.037.
[26]吴秀杰.老年自发性气胸92例临床观察与分析[J].北京医学,2017,39(8):888-889.
[27]刘慧峰,马连君,赵亚超,等.肺结核并发自发性气胸的治疗体会[J].北京医学,2017,39(10):1015-1017.
[28]李元博,支修益,张毅,等.胸腔镜手术治疗高龄气胸患者的临床体会[J].中国微创外科杂志,2017,17(1):19-21.doi:10.3969/j.issn.1009-6604.2017.01.006.
[29]曹纪伟,朱红军.单孔法与双孔法胸腔镜肺大疱切除术治疗自发性气胸的疗效比较[J].腹腔镜外科杂志,2017,22(7):508-510.
[30]李丹,徐美清,潘家华.胸腔镜成功救治超微儿支气管发育畸形并发难治性气胸1例[J].临床肺科杂志,2017,22(12):2324-2326.doi:10.3969/j.issn.1009-6663.2017.12.052.
[31]王军,赵霞.单孔胸腔镜手术治疗自发性气胸合并进行性血胸12例报告[J].腹腔镜外科杂志,2017,22(7):505-507.
[32]张远强,童华杰,杨金华,等.186例单孔胸腔镜手术治疗胸部疾病临床分析[J].重庆医学,2017,46(20):2800-2801.doi:10.3969/j.issn.1671-8348.2017.20.021.
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