Darling Gail E, Abdurahman Adel, Yi Qi-Long, Johnston Michael, Waddell Thomas K, Pierre Andrew, Keshavjee Shaf, Ginsberg Robert
Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
Ann Thorac Surg. 2005 Feb;79(2):433-7. doi: 10.1016/j.athoracsur.2004.07.009.
The purpose of this study is to compare the morbidity and mortality of right versus left pneumonectomy.
We used a retrospective review of pneumonectomies performed during the period 1990 to 2000 and included a meta-analysis of relevant literature.
There were 187 pneumonectomies: 68 right, 119 left. The primary study end point was in-hospital death. There were 11 deaths: 7 (10.3%) right, 4 (3.3%) left (p = 0.10). Six deaths were attributable to bronchopleural fistula and its subsequent complications. The risk of bronchopleural fistula was higher on the right (9 [13.2%]) versus left (6 [5.0%]; p = 0.0472), as was the mortality associated with bronchopleural fistula (4 of 9 [44%] right versus 2 of 6 [33%] left). Right pneumonectomies were more likely to require an intrapericardial or extended dissection (p = 0.003), hand-sewn bronchial closure (p < 0.0001), or the closure buttressed (p < 0.0001). By univariate analysis, factors associated with an increased mortality were bronchopleural fistula (p < 0.0001), hand-sewn closure (p = 0.001), and a history of smoking (p = 0.01). By multivariate analysis, the most important factor was bronchopleural fistula (odds ratio, 43.3; 95% confidence limits, 4.2 to 441.9; p = 0.002). A meta-analysis combining our results with those from the literature found increased mortality of right pneumonectomy with a relative risk of 3.39 (95% confidence limits, 2.10 to 5.48; p < 0.00001).
Right pneumonectomy is associated with a higher mortality even in the absence of induction therapy. This is primarily related to the increased risk of bronchopleural fistula on the right. The increased number of bronchopleural fistulas on the right may be attributable to more extensive resection. Addressing technical factors that contribute to early bronchopleural fistula may reduce the mortality of right pneumonectomy.
本研究旨在比较右肺切除术与左肺切除术的发病率和死亡率。
我们对1990年至2000年期间进行的肺切除术进行了回顾性研究，并纳入了相关文献的荟萃分析。
共进行了187例肺切除术，其中右肺68例，左肺119例。主要研究终点为院内死亡。共有11例死亡，右肺7例（10.3%），左肺4例（3.3%）（p = 0.10）。6例死亡归因于支气管胸膜瘘及其后续并发症。右肺支气管胸膜瘘的风险高于左肺（右肺9例[13.2%]，左肺6例[5.0%]；p = 0.0472），与支气管胸膜瘘相关的死亡率也是如此（右肺9例中的4例[44%]，左肺6例中的2例[33%]）。右肺切除术更有可能需要心包内或扩大解剖（p = 0.003）、手工缝合支气管闭合（p < 0.0001）或加固闭合（p < 0.0001）。单因素分析显示，与死亡率增加相关的因素有支气管胸膜瘘（p < 0.0001）、手工缝合闭合（p = 0.001）和吸烟史（p = 0.01）。多因素分析显示，最重要的因素是支气管胸膜瘘（比值比，43.3；95%置信区间，4.2至441.9；p = 0.002）。将我们的结果与文献结果进行荟萃分析发现，右肺切除术的死亡率增加，相对风险为3.39（95%置信区间，2.10至5.48；p < 0.00001）。
即使在没有诱导治疗的情况下，右肺切除术的死亡率也较高。这主要与右肺支气管胸膜瘘风险增加有关。右肺支气管胸膜瘘数量增加可能归因于切除范围更广。解决导致早期支气管胸膜瘘的技术因素可能会降低右肺切除术的死亡率。
