70岁以上食管癌患者术后肺部并发症危险因素分析

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.

Analysis of risk factors for postoperative pulmonary complications In elderly patients with esophageal cancer aged 70 years and over

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.