中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2011年
5期
285-288
,共4页
王宇昭%吴楠%陈晋峰%郑庆锋%冯源%王嘉%吕超%阎石%张力建%杨跃
王宇昭%吳楠%陳晉峰%鄭慶鋒%馮源%王嘉%呂超%閻石%張力建%楊躍
왕우소%오남%진진봉%정경봉%풍원%왕가%려초%염석%장력건%양약
肺肿瘤%手术后并发症%危险因素%老年人
肺腫瘤%手術後併髮癥%危險因素%老年人
폐종류%수술후병발증%위험인소%노년인
Lung neoplasms Postoperative complications Risk factors Aged
目的 探讨70岁以上老年肺癌病人手术治疗特点及影响术后并发症发生的危险因素.方法 回顾总结222例年龄≥70岁接受肺切除手术的老年肺癌病人临床资料.将术后出现严重并发症的病人纳入Ⅰ组,仅出现一般并发症的病人则纳入Ⅱ组,无并发症发生的病人纳入Ⅲ组.定义A1组=Ⅰ组+Ⅱ组,B1组=Ⅲ组,A2组=Ⅰ组、B2组=Ⅱ组+Ⅲ组.对可能影响术后并发症发生的危险因素分别在A1组与B1组间、A2组与B2组间进行单因素分析和二项logistic多因素回归分析.结果 术前161例病人合并其他疾病(72.5%).手术方式以单肺叶切除为主(64.9%),中位淋巴结清扫数为14个(0～57个).术后并发症总发生率63.5%,严重并发症发生率13.5%,围手术期死亡1.8%(4例).Logistic回归分析结果显示,影响术后总体并发症发生的独立危险因素为术前体重下降(P=0.020)、ASA分级(P＜0.001)、MVV(%预测值)(P=0.020)和淋巴结清扫数(P=0.004);影响术后严重并发症发生的独立危险因素为ASA分级(P=0.003)、MVV(%预测值)(P=0.018)和肿瘤位置(P=0.007).结论 重视术前体重下降及术中淋巴结清扫对70岁以上老年肺癌病人手术安全性的影响;对术前高ASA分级、低MVV(%预测值)水平以及肿瘤为中心型的70岁以上老年肺癌病人应特别加强围手术期管理以降低手术风险.
目的 探討70歲以上老年肺癌病人手術治療特點及影響術後併髮癥髮生的危險因素.方法 迴顧總結222例年齡≥70歲接受肺切除手術的老年肺癌病人臨床資料.將術後齣現嚴重併髮癥的病人納入Ⅰ組,僅齣現一般併髮癥的病人則納入Ⅱ組,無併髮癥髮生的病人納入Ⅲ組.定義A1組=Ⅰ組+Ⅱ組,B1組=Ⅲ組,A2組=Ⅰ組、B2組=Ⅱ組+Ⅲ組.對可能影響術後併髮癥髮生的危險因素分彆在A1組與B1組間、A2組與B2組間進行單因素分析和二項logistic多因素迴歸分析.結果 術前161例病人閤併其他疾病(72.5%).手術方式以單肺葉切除為主(64.9%),中位淋巴結清掃數為14箇(0～57箇).術後併髮癥總髮生率63.5%,嚴重併髮癥髮生率13.5%,圍手術期死亡1.8%(4例).Logistic迴歸分析結果顯示,影響術後總體併髮癥髮生的獨立危險因素為術前體重下降(P=0.020)、ASA分級(P＜0.001)、MVV(%預測值)(P=0.020)和淋巴結清掃數(P=0.004);影響術後嚴重併髮癥髮生的獨立危險因素為ASA分級(P=0.003)、MVV(%預測值)(P=0.018)和腫瘤位置(P=0.007).結論 重視術前體重下降及術中淋巴結清掃對70歲以上老年肺癌病人手術安全性的影響;對術前高ASA分級、低MVV(%預測值)水平以及腫瘤為中心型的70歲以上老年肺癌病人應特彆加彊圍手術期管理以降低手術風險.
목적 탐토70세이상노년폐암병인수술치료특점급영향술후병발증발생적위험인소.방법 회고총결222례년령≥70세접수폐절제수술적노년폐암병인림상자료.장술후출현엄중병발증적병인납입Ⅰ조,부출현일반병발증적병인칙납입Ⅱ조,무병발증발생적병인납입Ⅲ조.정의A1조=Ⅰ조+Ⅱ조,B1조=Ⅲ조,A2조=Ⅰ조、B2조=Ⅱ조+Ⅲ조.대가능영향술후병발증발생적위험인소분별재A1조여B1조간、A2조여B2조간진행단인소분석화이항logistic다인소회귀분석.결과 술전161례병인합병기타질병(72.5%).수술방식이단폐협절제위주(64.9%),중위림파결청소수위14개(0～57개).술후병발증총발생솔63.5%,엄중병발증발생솔13.5%,위수술기사망1.8%(4례).Logistic회귀분석결과현시,영향술후총체병발증발생적독립위험인소위술전체중하강(P=0.020)、ASA분급(P＜0.001)、MVV(%예측치)(P=0.020)화림파결청소수(P=0.004);영향술후엄중병발증발생적독립위험인소위ASA분급(P=0.003)、MVV(%예측치)(P=0.018)화종류위치(P=0.007).결론 중시술전체중하강급술중림파결청소대70세이상노년폐암병인수술안전성적영향;대술전고ASA분급、저MVV(%예측치)수평이급종류위중심형적70세이상노년폐암병인응특별가강위수술기관리이강저수술풍험.
Objective This study is to analyse the clinical feature and risk factors of morbidity after pulmonary resection for lung cancer in patients older than 70 years. Methods The clinical records of 222 patients older than 70 years who had undergone pulmonary resection for their lung cancer was reviewed. The patients were divided into 3 groups: group Ⅰ including the patients who had severe postoperative complications, group Ⅱ including the patients who had mild complications and group Ⅲ including the patients who had no complications. Moreover, the definitions were made that group A1 = group Ⅰ+ Ⅱ , group B1 = group Ⅲ, group A2 = group Ⅰ and group B2 = group Ⅱ + Ⅲ. Univariate analyses and multivariate binary logistic regressions relating postoperative morbidity to risk factors were performed between the group Al and Bl, A2 and B2, resulting in the identification of the independent risk factors for overall morbidity and major morbidity. Results Preoperative comorbidity was recorded in 161 patients (72.5%). Lobectomy (64.9% ) was the predominant surgical procedure. The median number of dissected LN was 14, with the range of 0 to 57. The overall morbidity was 63.5% , including major morbidity of 13.5%. Perioperative mortality was 1.8% (4 cases). The results of binary logistic regression analyses indicated that the independent risk factors for overall morbidity were preoperative weight loss (P =0.020), ASA score (P＜0.001), MVV (% predicted) (P=0. 020 ) and the number of dissected LN ( P = 0.004 ). The independent risk factors for major morbidity were ASA score ( P =0.003), MVV (% predicted) (P= 0.018) and the location of tumor (P=0.007). Conclusion Preoperative weight loss and numbers of dissected mediastinal lymph nodes were risk factor for lung cancer patients older than 70 years, Proper perioperative management for the elderly patients with high ASA score, low MVV (% predicted) or central tumor, could reduce the major postoperative morbidity.
