Kinugasa Shoichi, Tachibana Mitsuo, Yoshimura Hiroshi, Ueda Shuhei, Fujii Toshiyuki, Dhar Dipok Kumar, Nakamoto Takeru, Nagasue Naofumi
Department of Digestive and General Surgery, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan.
J Surg Oncol. 2004 Nov 1;88(2):71-7. doi: 10.1002/jso.20137.
Risk analysis of pulmonary complications after extended esophagectomy with three-field lymph node dissection (3FLND) has been little reported in the literature.
Risk factors of developing postoperative pneumonia after extended esophagectomy and its effects on in-hospital death and overall long-term survival were compared between 38 patients who developed pneumonia and 80 patients who did not.
Eight patients died of postoperative complications during the hospital stay after esophagectomy. Seven of those 8 patients developed pneumonia, whereas 31 patients of 110 patients who were discharged from the hospital developed pneumonia (P < 0.01). Pneumonia occurred more frequently in elderly patients (P < 0.01), in heavy smokers (P < 0.05), in patients with preoperative pulmonary obstructive dysfunction (P < 0.05), and in patients who received 3 U or more perioperative blood transfusion (P < 0.05). Five-year overall survival rate (26.7%) of 38 patients who developed pneumonia was significantly worse than 53.4% who did not develop pneumonia (P < 0.01). Multivariate analysis of prognostic factors for overall survival showed that pathological tumor stage (hazard ratio 5.380, P < 0.01) and pneumonia (hazard ratio 2.369, P < 0.01) were independent risk factors. Postoperative pneumonia is correlated with in-hospital death and poorer long-term survival after extended esophagectomy with 3FLND.
Elderly patients with a history of heavy smoking and poor pulmonary function should be regarded as a high-risk group of patients for developing pneumonia and very careful selection is required before subjecting such patients to extended esophagectomy.
关于扩大食管切除术联合三野淋巴结清扫术（3FLND）后肺部并发症的风险分析，文献报道较少。
比较了38例发生肺炎的患者和80例未发生肺炎的患者在扩大食管切除术后发生术后肺炎的危险因素及其对住院死亡和总体长期生存的影响。
8例患者在食管切除术后住院期间死于术后并发症。这8例患者中有7例发生了肺炎，而110例出院患者中有31例发生了肺炎（P<0.01）。肺炎在老年患者（P<0.01）、重度吸烟者（P<0.05）、术前有肺阻塞性功能障碍的患者（P<0.05）以及围手术期接受3单位或更多输血的患者（P<0.05）中更频繁发生。38例发生肺炎的患者的5年总生存率（26.7%）显著低于未发生肺炎的患者的53.4%（P<0.01）。对总生存预后因素的多变量分析表明，病理肿瘤分期（风险比5.380，P<0.01）和肺炎（风险比2.369，P<0.01）是独立危险因素。扩大食管切除术联合3FLND术后，术后肺炎与住院死亡和较差的长期生存相关。
有重度吸烟史且肺功能差的老年患者应被视为发生肺炎的高危患者群体，在对这类患者进行扩大食管切除术之前，需要非常谨慎地进行选择。
