振动反应成像诊断系统在肺切除术后近期预后中的临床应用价值

目的 探讨应用肺部振动反应成像诊断系统(VRI)预测肺部手术残余肺功能与术后近期预后的相关性.方法 将2009～2010年在我院行肺叶切除、两叶切除、全肺切除的138例患者,根据VRI预测的术后肺功能数值分为3组,A组预测术后肺功能FEV1>1.0 L,B组预测术后肺功能0.8 L0.05).C组患者术后并发症明显增高,与A、B两组有明显差别(P<0.05),尤其全肺切除术后并发症发生率升高明显(P<0.05).结论 VRI预测肺切除术后肺功能>0.8 L时,肺切除术(包括全肺切除)是安全的;预测术后肺功能<0.8 L时,并发症发生率明显增高,手术要慎重,术前准备要充分.     

不同通气麻醉对肺癌患者术后肺功能的影响

目的 探讨不同通气麻醉对肺癌患者术后肺功能的影响.方法 选择20例行单侧肺叶切除手术患者,随机分为两组各10例,单肺通气(OLV)组用双腔支气管导管行开胸术,双肺通气(TLV)组用加强型气管导管行开胸术.两组术前(T0)与术后第1天(T1)、第2天(T2)、第3天(T3)、第4天(T4)、第5天(T5)、第6天(T6)、第7天(T7)行肺功能指标检测,包括肺活量占预计值百分比(VC％)、用力肺活量占预计值百分比(FVC％)、最大自主通气量占预计值百分比(MVV％)、第1秒用力呼气量占预计值百分比(FEV1％)、FEV1/FVC.结果 两组VC％、FVC％、FEV1％、MVV％术后T1～T7均明显低于T0(P均＜0.05),FEV1/FVC术后T1 ～T7高于T0(P均＜0.05);组间比较P均＞0.05.结论 OLV不是影响肺科手术后肺功能变化的主要因素.     

肺功能显著损害病人的肺切除指征探讨

我们对32例最大自主通气量(MVV)预计值<50％的肺癌、肺结核、肺大疱患者进行了手术指征的探讨。32例中全肺切除术9例,肺叶切除术14例,肺段或肺部分切除术9例。肺功能降低情况为:MVV降低21.46～60.59升,平均39.91±11.5升;占预计值为23.23％～50.00％,平均43.78±9.74％。VC降低1.27～2.53升,平均1.89±0.36升;占预计值为39.16％～73.11％,平均56.18±11.29％。FEV_(1.0)降低0.75～1.64升,平均1.09±0.25升;FEV_(1.0)占用力呼气量百分比(FEV1.0/FVC)为41.3％～82.17％,平均66.12±11.58％。手术后发生呼吸、循环并发症者13例,肺衰、肺心衰死亡者3例。肺功能MVV40％以下者,并发症与死亡率分别为44.4％和20％;FEV_(1.0)少于1000ml者,分别为58％和     

全肺切除治疗低肺功能肺结核毁损肺患者的临床研究

目的探讨全肺切除治疗低肺功能肺结核毁损肺患者的临床应用价值。方法选择低肺功能肺结核毁损肺患者36例,所有患者均选择全肺切除术,其中左侧全肺切除19例,右侧全肺切除17例,术前及术后应用抗结核药物。观察患者治疗后的治愈率、肺结核转阴率、并发症发生情况及死亡率。比较患者术前、术后3、6个月肺功能情况。结果临床治愈35例,治愈率97.22%。术前痰培养阳性36例,术后痰培养阴性34例,转阴率为94.44%。术后患者肺功能逐渐改善,与术前相比,患者术后3个月及6个月FEV1、MVV水平均逐渐升高,其差异均具有统计学意义(P<0.05)。结论全肺切除在选择性低肺功能肺结核毁损肺患者的治疗中具有很高临床应用价值。     

高龄低肺功能食管癌患者手术治疗的研究

目的 :探讨高龄低肺功能食管癌病人外科手术治疗适应症、手术方式的选择及术后呼吸机的应用。方法 :4 6例 70岁以上食管癌患者依据最大通气量占预计值百分比 (MVV ,% )分为 2组 :第一组 ,MVV≤ 5 0 % 2 2例 ,第二组为对照组 :MVV >5 0 % 2 4例 ;第一组再分 2组 :1组MVV <4 0 % 3例 ,其中 2例术前FEV1 FVC <4 5 % ,1例FEV1 FVC >4 5 % ;2组 :MVV 4 0 %～ 5 0 % 19例 ,FEV1 FVC均 >4 5 %。第一组患者术后均使用呼吸机辅助呼吸。对比研究 1组、2组患者及对照组呼吸衰竭、心律失常发生情况。结果 :各组无手术死亡 ;1组中 2例 (FEV1 FVC <4 5 % )同时发生呼吸衰竭及心房颤动 ;2组中 4例病人出现心律失常 ,无呼吸衰竭 ;对照组中 5例病人出现心律失常 ,无呼吸衰竭。结论 :由于手术技术提高和术后呼吸机的应用 ,可相对扩大手术适应征     

术前肺功能对肺切除术术后并发症及术后肺功能的预测

目的观察肺切除手术患者术前、后肺功能演变特征,探讨术前肺功能指标对患者术后并发症和术后肺功能的预测能力。方法对115例肺切除手术患者进行术前常规肺功能及运动心肺功能检测,术后3个月行肺功能复查;追踪患者1个月内术后心肺并发症(PPC)的发生情况。结果28例手术患者出现PPC(24.35%);有、无PPC组间比较有差异的肺功能指标为:FVC%pred、FEV1%pred、VO2m ax%pred、WRm ax%pred、VO2/HR%pred;术后肺通气功能、运动心肺功能与术前比较有不同程度下降;术后肺功能实测值与公式法预计的术后肺功能值比较差异有显著性。结论术后肺功能损害主要是限制性肺通气功能障碍,运动心肺功能亦有下降。建立预测PPC及术后肺功能的回归方程,能更准确地评估患者的手术耐受力。     

肺功能预测高龄患者胸腔手术的疗效

我们测定了34例年龄70～82岁的肺癌、肺结核、肺大泡、食管贲门癌患者胸腔手术(肺段或肺部分切除6例,肺叶切除11例,全肺切除1例,食管贲门癌切除食管胃吻合术16例)前的最大通气量(MVV)及第1秒最大呼气量(FEV_(1.0))。结果发现,MVV占预计值80％以上者9例,其手术顺利,无死亡;占60％～80％者19例,其中1例因吻合口瘘死亡;占60％以下者6例,其中2例术后死于肺炎、肺功能不全。FEV_(1.0)2000ml以上者10例,1例死于吻合口瘘;1500～2000ml者16例,无死亡者;1500ml以下者8例,2例术后死于肺炎、肺功能不全。分析以上结果我们认为,凡老年人术前最大通气量占预计值百分比低于60％,第1秒最大呼气量少于1500ml者,不宜行胸外科手术,即使检测数值达到上述要求,亦应结合患者的全身状况及手术范围全面考虑,综合分析其对手术的耐受能力,并做好充分     

肺功能与肺癌手术结果之间的关系

英国胸科协会与美国胸科医师学会提出了调研肺癌手术病人的指导准则。然而．这个准则是基于相对比较旧的研究。因此．关于肺功能检测结果与手术结果之间的关系须在一大批肺癌病人中进行前瞻性研究。从2001年1月到2003年12月110例病人进行了手术。为了预测术后肺功能。所有病人都进行了全肺功能检测。院内死亡率为3％，严重并发症发生率为22％。13％的病人术后综合预后差。平均术前肺功能检测值分别为：1秒用力肺活量(FEV1.0)为2．0L(预计值的79．4％)，CO弥散量(DLCO)为预计值的73．6％。术后平均肺功能值分别为：FEV1.0为1．4L(预计值的55．6％)，DLCO为预计值的53．1％。用预计值的百分比来表示全部肺功能值能更好地预示手术结果的好坏。     

肺癌微创切除术与术前肺功能的相关性

目的探讨肺癌患者术前肺功能与微创切除术后肺部并发症的相关性研究。方法回顾性研究我院126例微创切除术后的肺癌患者,分析并发症发生情况及术前第一秒呼气容量(FEV1)和一氧化碳弥散量(DLco)与术后并发症的相关性。结果无并发症组(A组)和并发症组(B组)在ppoFEV1、DLco占预计值的百分值及ppoDLco方面,A组明显高于B组,两者比较有明显统计学意义(P0.05)。Logistic回归分析提示只有DLco占预计值百分比与肺部并发症的发生呈负相关(P0.05)。结论 DLco占预计值百分比与肺部并发症的发生呈负相关。     

全腔镜解剖性肺段切除术对比肺叶切除术在治疗早期肺癌的前瞻性研究

目的前瞻性对比研究完全胸腔镜下解剖性肺段切除术与肺叶切除术治疗早期肺癌的临床效果,评估全腔镜解剖性肺段切除术在早期肺癌的应用价值。方法将肺部小结节(CT上直径≤2cm)患者随机分入全腔镜解剖性肺段切除术组及肺叶切除术组。比较其手术并发症、术后肺功能及手术短期效果。结果两组分别入组35例。无中转开胸,无围术期死亡,解剖性肺段切除组手术时间长于肺叶切除组(P0.05),但解剖性肺段切除术组术后住院时间少于肺叶切除术组(P0.05)。两组术中出血量、清扫淋巴结个数、术后引流时间、术后并发症发生率、术后1年生存率及复发率比较均无明显差异(P0.05)。两组患者术后1年用力肺活量(FVC)、第1秒钟用力呼气量与用力肺活量比值(FEV1%)及最大通气量(MVV)均较术前下降,但解剖性肺段除组术后下降比例较小(P0.05)。结论完全胸腔镜下解剖性肺段切除术与肺叶切除术治疗早期肺癌并发症相似,短期疗效无明显差异,但解剖性肺段切除术对于患者肺功能的保护更为好,可能对提高患者术后生活质量有帮助。     

Preoperative assessment as a predictor of mortality and morbidity after lung resection

To refine the functional guidelines for operability for lung resection, we prospectively studied 55 consecutive patients with suspected lung malignancy thought to be surgically resectable. Lung function and exercise capacity were measured preoperatively and at 3 and 12 months postoperatively. Preoperative pulmonary scintigraphy was used to calculate the contribution to overall function by the affected lung or lobe and to predict postoperative lung function. Pneumonectomy was performed in 18 patients, lobectomy in 29, and thoracotomy without resection in six. No surgery was attempted in two patients who were considered functionally inoperable. Cardiopulmonary complications developed in 16 patients within 30 days of surgery, including three deaths. The predictions of postoperative function correlated well with the measured values at 3 months. For FEV1, r = 0.51 in pneumonectomy (p less than 0.05) and 0.89 in lobectomy (p less than 0.001). Predicted postoperative FEV1 (FEV1-ppo), diffusing capacity (DLCO), predicted postoperative DLCO (DLCO-ppo) and exercise-induced arterial O2 desaturation (delta SaO2) were predictive of postoperative complications including death and respiratory failure. In patients who underwent pneumonectomy, the best predictor of death was FEV1-ppo. The predictions were enhanced by expressing the value as a percentage of the predicted normal value (% pred) rather than in absolute units. For the entire surgical group a FEV1-ppo greater than or equal to 40% pred was associated with no postoperative mortality (n = 47), whereas a value less than 40% pred was associated with a 50% mortality (n = 6), suggesting that resection is feasible when FEV1-ppo is greater than or equal to 40% pred.(ABSTRACT TRUNCATED AT 250 WORDS)     

脉冲振荡肺功能在COPD分级诊断中的应用价值

目的探讨脉冲振荡肺功能（IOS）与常规肺功能（PFT）各参数间的相关性,研究IOS各参数在慢性阻塞性肺疾病（COPD）气道阻塞程度分级及诊断中的临床价值。方法对325例受试者（154例COPD患者及171例健康对照组）依次进行IOS检测和PFT检测。结果 COPD组IOS各参数与PFT参数用力肺活量占预计值百分比（FVC%pre）、第1秒用力呼气容积占预计值百分比（FEV1%pre）、第1秒用力呼气容积与用力肺活量之比（FEV1/FVC）、最大通气量占预计值百分比（MVV%pre）呈负相关（P〈0.01）,与残气与肺总量之比（RV/TLC）、气道阻力占预计值百分比（R tot%pre）呈正相关（P〈0.01）。IOS各参数中对COPD的诊断价值按顺序排列依次是低频电抗面积（AX）〉共振频率（Fres）〉振荡频率为5Hz时的电抗（X5）〉振荡频率为5Hz时的气道阻力（R5）〉振荡频率为5Hz和20Hz时气道阻力差值（R5-R20）〉振荡频率为20Hz时的气道阻力（R20）。IOS分级方法与COPD的GOLD分级方法显著相关（P〈0.01）。结论 IOS参数中的AX、Fres、X5及R5可综合用于对COPD气流阻塞程度及病情严重程度的分级。     

Morbimortalidad de la resección pulmonar en pacientes octogenarios con cáncer de pulmón

ObjectiveEvaluate the restrictiveness of selection criteria for lung resection in lung cancer patients over 80 years of age compared to those applied in younger patients. Compare and analyze 30-day mortality and postoperative complications in both groups of patients.MethodsCase-controlled retrospective analysis. Study population: Consecutive patients undergoing elective anatomical lung resection. Population was divided into octogenarians (cases) and younger patients (controls). Variables determining surgical risk (BMI, FEV1%, postoperative FEV1%, FEV1/FVC, DLCO and pneumonectomy rate) were compared using either Wilcoxon or Chi-squared tests. Thirty-day mortality and morbidity odds ratio were calculated. A logistic regression model with bootstrap resampling was constructed, including postoperative complications as dependent variable and age and post-operative FEV1% as independent variables. Data were retrieved from a prospective database.ResultsNo statistically significant differences were found in BMI (P=.40), FEV1% (P=.41), postoperative FEV1% (P=.23), FEV1/FVC (P=.23), DLCO (P=.76) and pneumonectomy rate (P=.90). Case mortality was 1.85% and control mortality was 1.26% (OR: 1.48). Cardiorespiratory complications occurred in 12.80% of younger subjects and in 13.21% of patients aged 80 years or older. (OR: 1.03). In the logistic regression, only FEV1% was related to postoperative complications (P<.005).ConclusionSelection criteria for octogenarians are similar to those applied in the rest of the population. Advanced age is not a factor for increased 30-day mortality or postoperative morbidity.     

Preoperative maximal exercise oxygen consumption test predicts postoperative pulmonary morbidity following major lung resection

BACKGROUND AND OBJECTIVE: Pulmonary resection carries a significant morbidity and mortality. The utility of maximal oxygen uptake test (VO(2)max) to predict cardiopulmonary complications following major pulmonary resection was evaluated. METHODS: Following standard preoperative work-up and VO(2)max testing, 55 patients (49 male; mean age 59 years, range 20-74) underwent major pulmonary surgery: lobectomy (n = 31), bilobectomy (n = 6) and pneumonectomy (n = 18). An investigator blinded to the preoperative assessment prospectively collected data on postoperative cardiopulmonary complications. Patients were divided into two groups according to preoperative VO(2)max and also according to FEV(1). The frequency of postoperative complications in the groups was compared. RESULTS: Complications were observed in 19 (34.5%) patients, 11 of which were pulmonary (20%). There were two deaths (3.6%), both due to respiratory failure. Preoperative FEV(1) failed to predict postoperative respiratory complications. Five of 36 patients with a preoperative FEV(1) > 2 L suffered pulmonary complications, compared with six of 19 patients with FEV(1) < 2 L. Cardiopulmonary complications were not observed in patients with VO(2)max > 15 mL/kg/min (n = 27); however, 11 patients with VO(2)max < 15 mL/kg/min (n = 28) suffered cardiopulmonary complications (P < 0.05). CONCLUSION: VO(2)max predicts postoperative pulmonary complications following major lung resection, and the risk of complications increases significantly when the preoperative VO(2)max is less than 15 mL/kg/min.     

维生素C在慢阻肺疾病急性加重患者治疗中的研究

目的探讨维生素C在慢性阻塞性肺疾病(简称:慢阻肺)加重患者治疗中的价值。方法选取60例中、重度慢阻肺急性加重住院患者为研究对象,随机分为治疗组和对照组,对照组给予抗炎、氧疗、平喘等常规治疗,治疗组在常规治疗的基础上给予维生素C口服,测定两组治疗前、治疗10天及20天后血清中丙二醛(malonaldehyde,MDA)、谷胱甘肽(glutathione,GSH)、超氧化物歧化酶(superoxide dismutase,SOD)以及第一秒用力呼气容积占预计值(FEV_1%pre)、呼吸困难评分等。比较两组治疗效果。结果治疗组10天、20天后测定的GSH、SOD及FEV_1%pre较治疗前均有升高、MDA及呼吸困难评分较治疗前均有降低,而20天后测定的GSH及SOD较治疗10天后升高、MDA及呼吸困难评分较治疗10天后降低,差异均有统计学意义(P0.05),但治疗10天与20天后测定的FEV_1%pre无差异(P0.05)。对照组治疗前、治疗10天、20天后在MDA、GSH、SOD、FEV_1%pre、呼吸困难评分方面均无统计学差异(P0.05)。治疗组治疗10天、20天后在相应时间测定的GSH、SOD、FEV_1%pre均高于对照组、MDA及呼吸困难评分均低于对照组,但两组在治疗10天后测定的MDA、FEV_1%pre之间无统计学差异(P0.05),其余差异均有统计学意义(P0.05)。治疗组的住院天数(10.77±1.63天)较对照组(13.50±2.06天)缩短,两者之间有统计学差异(P0.05)。治疗组未发现不良反应。结论维生素C能提高慢阻肺急性加重患者抗氧化能力、减轻氧化应激程度,改善患者肺功能,缩短住院天数。     

Functional evaluation before lung resection

Advances in operative technique and perioperative care have reduced surgical morbidity and mortality considerably after pulmonary resections. Various single and combined parameters of functional operability have been proposed to assess the surgical risk. Patients with normal or only slightly impaired pulmonary function (FEV1 and DLCO > or = 80% predicted) and no cardiovascular risk factors can undergo pulmonary resections up to a pneumonectomy without further investigation. For others, exercise testing, pulmonary split-function studies, or a combination of these methods are recommended. Cardiopulmonary exercise testing, most frequently performed as a symptom-limited test with the measurement of VO2max, assesses the pulmonary and cardiovascular reserves. A VO2max of less than 10 mL/kg/minute generally is considered prohibitive for any resection, a value of greater than 20 mL/kg/minute or greater than 75% predicted normal, safe for major resections. Split-function studies are radionuclide-based estimations of the ppo values of various parameters. The currently used ppo parameters are FEV1-ppo, DLCO-ppo, and VO2max-ppo. Suggested cutoff values for safe resection are: FEV1-ppo and DLCO-ppo 40% or greater than predicted, and V(r)O2max-ppo 35% or greater than predicted, combined with an absolute value of greater than or equal to 10 mL/kg/minute. The lowest acceptable ppo values remain to be confirmed by additional prospective studies. Resections involving not more than one lobe usually lead to an early functional deficit followed by recovery. The permanent loss in pulmonary function is small (approximately 10%) and exercise capacity is reduced only slightly or not at all. Pneumonectomy leads to an early permanent loss of about 33% in pulmonary function and approximately 20% in exercise capacity. Pulmonary function tests alone therefore overestimate the functional loss after lung resection.     

Preoperative evaluation of patients undergoing lung resection surgery

Lung cancer continues to be the leading case of cancer deaths in the United States. In patients with resectable non-small cell lung cancer, surgical resection is the treatment of choice. An accurate preoperative general and pulmonary-specific evaluation is essential as postoperative complications and morbidity of lung resection surgery are significant. After confirming anatomic resectability, patients must undergo a thorough evaluation to determine their ability to withstand the surgery and the loss of the resected lung. The measurement of spirometric indexes (ie, FEV(1)) and diffusing capacity of the lung for carbon monoxide (DLCO) should be performed first. If FEV(1) and DLCO are > 60% of predicted, patients are at low risk for complications and can undergo pulmonary resection, including pneumonectomy, without further testing. However, if FEV(1) and DLCO are < 60% of predicted, further evaluation by means of a quantitative lung scan is required. If lung scan reveals a predicted postoperative (ppo) values for FEV(1) and DLCO of > 40%, the patient can undergo lung resection. If the ppo FEV(1) and ppo DLCO are < 40%, exercise testing is necessary. If this reveals a maximal oxygen uptake (O(2)max) of > 15 mL/kg, surgery can be undertaken. If the O(2)max is < 15 mL/kg, surgery is not an option. This review discusses the existing modalities for preoperative evaluation prior to lung resection surgery.     

Preoperative predictors of prolonged postoperative mechanical ventilation in children following scoliosis repair

Scoliosis is associated with progressive restrictive lung disease and an increased risk of pulmonary complications following surgical correction. Identification of higher risks for prolonged postoperative mechanical ventilation (MV) improves postoperative care. Our objective was to determine if preoperative pulmonary function tests (PFT) predict prolonged postoperative MV (defined as MV >or=3 days). We correlated preoperative PFT (forced expired volume in 1 sec, FEV1; vital capacity, VC; inspiratory capacity, IC; maximal inspiratory pressure, MIP; total lung capacity, TLC; and residual volume, RV) and postoperative MV days in 125 patients who had scoliosis surgery (aged 13.7 +/- 3.0 (SD) years) from January 1990-July 2001. We had 71 male and 54 female patients. Scoliosis types were 13 congenital, 27 idiopathic, 57 neuromuscular, 23 syndrome/tumor, and 5 kyphoscoliosis. Forty patients (32%) had postoperative MV >or=3 days. Independent factors likely requiring postoperative MV >or=3 days were neuromuscular scoliosis (P < 0.001) and FEV1 <40% predicted. Independent factors most likely were: neuromuscular scoliosis with preoperative FEV1 <40% predicted (P < 0.01). Independent factors most unlikely were: idiopathic scoliosis (P < 0.002). VC <60% predicted, IC <30 ml/kg, TLC <60% predicted, and MIP <60 cm H2O correlated with postoperative MV >or=3 days (P < 0.05). We found no association between RV and postoperative MV. FEV1 <40% predicted, VC <60% predicted, IC <30 ml/kg, TLC <60% predicted, MIP <60 cm H2O, and neuromuscular disease each correlated with prolonged postoperative MV. Neuromuscular disease or a preoperative FEV(1) <40% predicted were more likely, and older children with neuromuscular disease and FEV1 <40% predicted were most likely to require prolonged postoperative MV (P < 0.01). Clearly FEV1, and possibly VC, IC, TLC, and MIP, may increase accuracy in predicting the need for prolonged postoperative MV.     

Respiratory function after esophagectomy for patients with esophageal cancer

BACKGROUND/AIMS: Postoperative respiratory hypofunction sometime ruins quality of life of patients with esophageal cancer. From 1993, we introduced transhiatal esophagectomy without thoracotomy as a less invasive surgery to prevent postoperative respiratory complications for patients who have relatively early stage of esophageal cancer and have preoperative respiratory complication, or who are older in age. In this study, postoperative long-term evaluation of respiratory functions of patients with esophageal cancer who underwent esophagectomy was performed. METHODOLOGY: Among the patients with esophageal cancer who underwent esophagectomy in our hospital between 1993 and 1995, we selected 13 patients who underwent transhiatal esophagectomy (transhiatal group) and 9 patients who underwent transthoracic esophagectomy (transthoracic group). Conventional respiratory function tests (VC, vital capacity; FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; FEV1/FVC, ratio of FEV1 to FVC; PEF, peak expiratory flow) were compared between the two groups at 3, 6, and 12 months after operation. RESULTS: In the transhiatal group, postoperative average values of VC, FVC, and FEV1 recovered 92%, 98%, and 93% of preoperative average values at 6 months after operation, while in the transthoracic group, the average values of VC, FVC, and FEV1 were still 78%, 78%, and 72% of preoperative average values at 6 months after operation. Postoperative respiratory complications were detected in 4 patients (transhiatal: 2 and transthoracic: 2). The recovery rates of VC, FVC, FEV1, FEV1/FVC, and PEF at 6 months after operation of these 4 patients were not different from those of 18 patients without postoperative respiratory complications. CONCLUSIONS: In patients treated with transthoracic esophagectomy, postoperative respiratory hypofunctions continued over 6 months after surgery. However, postoperative respiratory complications may not be related with the long-term postoperative respiratory hypofunction in patients with esophageal cancer.     

Pulmonary complications in patients with chronic obstructive pulmonary disease following transthoracic esophagectomy

AIM: To investigate the incidence of various types of postoperative pulmonary complications (POPCs) and to evaluate the significance of perioperative arterial blood gases in patients with esophageal cancer accompanied with chronic obstructive pulmonary disease (COPD) after esophagectomy. MEHTODS: Three hundred and fifty-eight patients were divided into POPC group and COPD group. We performed a retrospective review of the 358 consecutive patients after esophagectomy for esophageal cancer with or without COPD to assess the possible influence of COPD on postoperative pulmonary complications. We classified COPD into four grades according to percent-predicted forced expiratory volume in 1 s (FEV1) and analyzed the incidence rate of complications among the four grades. Perioperative arterial blood gases were tested in patients with or without pulmonary complications in COPD group and compared with POPC group. RESULTS: Patients with COPD (29/86, 33.7%) had more pulmonary complications than those without COPD (36/272, 13.2%) (P<0.001). Pneumonia (15/29, 51.7%), atelectasis (13/29, 44.8%), prolonged 02 supplement (10/29, 34.5%), and prolonged mechanical ventilation (8/29, 27.6%) were the major complications in COPD group. Moreover, patients with severe COPD (grade n B, FEV1 < 50% of predicted) had more POPCs than those with moderate(gradeⅡA,50%-80% of predicted) and mild (gradeⅠ≥80% of predicted) COPD (P<0.05). PaO2 was decreased and PaCO2 was increased in patients with pulmonary complications in COPD group in the first postoperative week. CONCLUSION: The criteria of COPD are the critical predictor for pulmonary complications in esophageal cancer patients undergoing esophagectomy. Severity of COPD affects the incidence rate of the pulmonary complication, and percent-predicted FEV1 is a good predictive variable for pulmonary complication in patients with COPD. Arterial blood gases are helpful in directing perioperative management.