CAJ | 학술논문

目的探讨非小细胞肺癌全肺切除术后早期支气管胸膜瘘发生的危险因素,建立一个可以评估其风险的临床模型,为早期干预提供可能.方法回顾性分析429例非小细胞肺癌全肺切除术患者,通过单因素和多因素分析发现非小细胞肺癌全肺切除术后早期支气管胸膜瘘发生的独立危险因素,综合独立危险因素建立临床模型.结果早期支气管胸膜瘘发生率为6.5％(28/429),其相关独立危险因素分别为新辅助治疗(HR:2.406)、围术期失血量(HR:2.171)、术前合并糖尿病(HR:1.144).根据相对危险比建立新的评分系统,新辅助治疗和围术期失血量≥1000ml定义为2分,术前合并糖尿病定义为1分.视每位患者得分情况分为3组:低危组(0～1分),中危组(2～3),高危组(＞3),术后早期支气管胸膜瘘发生率分别为3.0％、11.3％和55.6％(P＜0.000).结论这个临床模型建立在独立危险因素基础上,可以作为预测非小细胞肺癌全肺切除术后发生早期支气管胸膜瘘的工具,为提早干预提供依据.
목적 탐토비소세포폐암전폐절제술후조기지기관흉막루발생적위험인소,건립일개가이평고기풍험적림상모형,위조기간예제공가능.방법 회고성분석429례비소세포폐암전폐절제술환자,통과단인소화다인소분석발현비소세포폐암전폐절제술후조기지기관흉막루발생적독립위험인소,종합독립위험인소건립림상모형.결과 조기지기관흉막루발생솔위6.5％(28/429),기상관독립위험인소분별위신보조치료(HR:2.406)、위술기실혈량(HR:2.171)、술전합병당뇨병(HR:1.144).근거상대위험비건립신적평분계통,신보조치료화위술기실혈량≥1000ml정의위2분,술전합병당뇨병정의위1분.시매위환자득분정황분위3조:저위조(0～1분),중위조(2～3),고위조(＞3),술후조기지기관흉막루발생솔분별위3.0％、11.3％화55.6％(P＜0.000).결론 저개림상모형건립재독립위험인소기출상,가이작위예측비소세포폐암전폐절제술후발생조기지기관흉막루적공구,위제조간예제공의거.
Objective To evaluate prognostic factors for early bronchopleural fistula after pneumonectomy with non small cell lung cancer,and establish a validated clinical model to estimate the risk of early-BPF.Methods We reviewed the medical records of 429 patients who underwent pneumonectomy for NSCLC at our institution.We used univariate and multivariate analysis to identify potential independent risk factors for early-BPF after pneumonectomy for NSCLC.A model to estimate risk of early-BPF was developed by combining independent risk factors.Results The rate of early-BPF after pneumonectomy for NSCLC was 6.5％ (28/429).Three factors were independently associated with early-BPF:neoadjuvant therapy (HR:2.406),bleeding (HR:2.171)and diabetes (HR:1.144).A scoring system for early-BPF was developed by assigning 2 points for each major risk factor (neoadjuvant therapy and bleeding) and 1 point for each minor risk factor(diabetes).Scores were grouped as low (0-1),intermediate (2-3),and high (3),yielding the rate of early-BPF was 14％,27％,and 43％,respectively.Conclusion This clinical model is established on the basis of independent risk factors.This model can be used as a predictive tool for early-BPF after pneumonectomy for NSCLC.