CAJ | 학술논문

目的分析70岁以上食管癌患者手术后发生肺部并发症及相关死亡的各种危险因素,评估其危险度,为防治提供参考. 方法回顾185例70岁以上食管癌患者术后肺部并发症及相关死亡情况,采用单因素和多因素方法分析其危险因素. 结果 185例食管癌手术患者年龄70～86岁,中位年龄72岁.36例(19.5%)术后发生肺部并发症,其中肺炎23例(63.8%),肺不张3例(8.3%),成人型呼吸窘迫综合征(ARDS)2例(5.5%),肺栓塞1例(2.7%),呼吸衰竭7例(19.4%).相关死亡11例(5.9%),其中死亡原因肺炎4例,ARDS 1例,肺栓塞1例,呼吸衰竭5例.43例(23.2%)患者术前肺功能1秒钟用力呼气容积(FEV1)占用力肺活量(FVC)比值(FEV1%)<65%.术中出血量200～2000 ml,平均约350 ml,其中8例(4.3%)出血量大于800 ml.术中喉返神经损伤后出现声音嘶哑的患者有13例(7.0%).术后发生肺部并发症的独立危险因素为长期吸烟史、肥胖、肺功能FEV1%<65%、术中出血最大于800 ml和术中喉返神经损伤,而相关死亡的独立危险因素为术中出血量大于800 ml(OR=32.93,P=0.011)、术前肺功能FEV,%<65%(OR=29.49,P=0.023)和术中喉返神经损伤(OR=10.14,P=0.034). 结论 70岁以上食管癌患者术后发生肺部并发症及死亡的风险较大,与老年人生理病理特点有关,更与手术操作有密切关系.
목적 분석70세이상식관암환자수술후발생폐부병발증급상관사망적각충위험인소,평고기위험도,위방치제공삼고. 방법회고185례70세이상식관암환자술후폐부병발증급상관사망정황,채용단인소화다인소방법분석기위험인소. 결과 185례식관암수술환자년령70～86세,중위년령72세.36례(19.5%)술후발생폐부병발증,기중폐염23례(63.8%),폐불장3례(8.3%),성인형호흡군박종합정(ARDS)2례(5.5%),폐전새1례(2.7%),호흡쇠갈7례(19.4%).상관사망11례(5.9%),기중사망원인폐염4례,ARDS 1례,폐전새1례,호흡쇠갈5례.43례(23.2%)환자술전폐공능1초종용력호기용적(FEV1)점용력폐활량(FVC)비치(FEV1%)<65%.술중출혈량200～2000 ml,평균약350 ml,기중8례(4.3%)출혈량대우800 ml.술중후반신경손상후출현성음시아적환자유13례(7.0%).술후발생폐부병발증적독립위험인소위장기흡연사、비반、폐공능FEV1%<65%、술중출혈최대우800 ml화술중후반신경손상,이상관사망적독립위험인소위술중출혈량대우800 ml(OR=32.93,P=0.011)、술전폐공능FEV,%<65%(OR=29.49,P=0.023)화술중후반신경손상(OR=10.14,P=0.034). 결론 70세이상식관암환자술후발생폐부병발증급사망적풍험교대,여노년인생리병리특점유관,경여수술조작유밀절관계.
Objective To analyze the risk factors for postoperative pulmonary complications (PPCs) in elderly patients with esophageal cancer aged 70 years and over. Methods 185 elderly patients aged 70 years and over after esophagectomy were retrospectively analyzed. Univariate and multivariate logistic regression analysis were used to examine the risk factors for PPCs and related mortality. Results In 185 elderly patients from 70 to 86 years of age with a median age of 72 years, PPCs occurred in 36 patients(19.5%) including pneumonia in 23(63.8%) cases, atelectasis in 3 (8.3%) cases, adult respiratory distress syndrome (ARDS) in 2(5.5%) cases, pulmonary embolism in 1(2.7%) case and respiratory failure in 7(19.4%) cases. The related mortality was 5.9% (11cases) and the causes of death were pneumonia (4 cases), ARDS (1 case), pulmonary embolism (1case) and respiratory failure (5 cases). There were 43 (23.2%) cases with the forced expiratory volume in one second (FEV1%)< 65% before operation. The bleeding volume during operation ranged from 200ml～2000 ml, with a mean volume of about 350ml, and was above 800ml in 8(4.3%) cases. Injury of recurrent laryngeal nerve during operation occurred in 13(7.0%) cases. Univariate and multivariate logistic regression analysis indicated that smoking, obesity, poor preoperative pulmonary function (FEV1 % < 65%), bleeding volume over 800ml during operation and injury of recurrent laryngeal nerve were the independent risk factors for PPCs in elderly patients with esophageal cancer aged 70 years and over. Poor preoperative pulmonary function (FEV1% < 65%)(OR=29.49, P=0.023), bleeding volume over 800ml during operation(OR=32.93, P=0.011) and injury of recurrent laryngeal nerve(OR= 10.14, P= 0.034) were also the independent risk factors for related mortality of PPCs. Conclusions The high risks of PPCs and related mortality in elderly patients with esophageal cancer are not only due to the physiological and pathological characteristics of elderly people, but also due to the operative manipulation.