摘要
目的分析电视胸腔镜食管癌微创手术后呼吸衰竭发生风险的影响因素。方法胸腔镜食管癌微创手术后发生呼吸衰竭病人55例为呼吸衰竭组,术后无呼吸衰竭病人95例为对照组。比较两组性别、年龄、吸烟史、术前肺功能、术前合并症、手术时间以及术后病发症等因素对呼吸衰竭发生风险的影响。使用SPSS软件统计分析数据,采用单因素和多因素Logistic回归分析食管癌术后发生呼吸衰竭的危险因素。结果单因素分析显示,高龄(年龄≥70岁)、吸烟、术前肺部合并症、手术时间> 3小时、术后吻合口瘘、发生乳糜胸可能是呼吸衰竭发生的危险因素;呼吸衰竭组术前最大通气量(MVV%)为(51. 02±7. 69),第1秒用力呼气容积(FEV1%)为(39. 05±6. 47),对照组分别为(85. 64±8. 10)和(74. 29±7. 28),以上差异均有统计学意义(P <0. 05)。Logistic多因素回归分析显示,年龄≥70岁、手术时间> 3小时、术前肺功能偏低及术后吻合口瘘、乳糜胸(B值分别为1. 313、1. 345、1. 489、1. 579和1. 574)均为引起电视胸腔镜食管癌微创手术后发生呼吸衰竭的独立因素(P <0. 05)。结论接受电视胸腔镜食管癌微创手术病人术前改善肺功能,缩短手术时间,减少术后吻合口瘘、乳糜胸发生有助于预防术后呼吸衰竭的发生。
Objective To analyze the effect of potential factors on the risk of respiratory failure after minimally invasive surgery for video-assisted thoracoscopic esophageal cancer. Methods A total of55 patients with respiratory failure after minimally invasive surgery for thoracic esophageal cancer were enrolled in the respiratory failure group. 95 patients with no respiratory failure were included in the control group. The effects of gender,smoking,preoperative lung function（ including MVV% and FEV1%）,preoperative pulmonary comorbidities,preoperative hypoproteinemia,and operative time on the risk of respiratory failure were discussed. Statistical analysis data were performed using SPSS software,and single factor and multivariate logistic regression were used to analyze risk factors for respiratory failure after esophageal cancer surgery. Results Univariate analysis showed that advanced age（ ≥70 years）,smoking,preoperative pulmonary complication,operative time 〉3 h,postoperative anastomotic leakage,and chylothorax may be risk factors for respiratory failure. Preoperative maximum ventilation（ MVV%） of group respiratory failure was 51. 02 ± 7. 69 and the first second forced expiratory volume（ FEV1%） was 39. 05 ± 6. 47,which were lower than the control group（ 85. 64 ± 8. 10,74. 29 ± 7. 28,respectively,P〈0. 05）. Logistic multivariate regression analysis showed that age ≥ 70,operation time 〉3 h,low preoperative lung function and postoperative anastomotic fistula and chylothorax（ B values of 1. 313,1. 345、1. 489,1. 579,1. 574,respectively） were ndependent factors of respiratory failure after minimally invasive surgery for video-assisted thoracoscopic esophageal cancer（ P〈0. 05）. Conclusion Preoperative improvement of lung function,shortening operation time,reducing the incidence of postoperative anastomotic fistula and chylothorax which can help prevent postoperative respiratory failure.
作者
王涛
贾建博
辛向兵
朱爱林
WANG Tao;JIA Jiaabo;XIN Xiangbing(Department of Thoracic surgery,the Second Affiliated Hospital of the Air Force Medical University of the Chinese people＆ Liberation Army,Xi＇an 710038,China)
出处
《临床外科杂志》
2018年第9期668-670,共3页
Journal of Clinical Surgery
关键词
电视胸腔镜
食管癌
呼吸衰竭
风险
video-assisted thoracoscopy
esophageal cancer
respiratory failure
risk
