Sánchez Pablo Gerardo, Vendrame Giovani Schirmer, Madke Gabriel Ribeiro, Pilla Eduardo Sperb, Camargo José de Jesus Peixoto, Andrade Cristiano Feijó, Felicetti José Carlos, Cardoso Paulo Francisco Guerreiro
Internal Medicine, Federal University of RioGrande do Sul, Porto Alegre, Brazil.
J Bras Pneumol. 2006 Nov-Dec;32(6):495-504. doi: 10.1590/s1806-37132006000600005.
To analyze the impact that comorbidities have on the postoperative outcomes in patients submitted to lobectomy for the treatment of bronchial carcinoma.
A retrospective study of 493 patients submitted to lobectomy for the treatment of bronchial carcinoma was conducted, and 305 of those patients met the criteria for inclusion in the final study sample. The surgical technique used was similar in all cases. The Torrington-Henderson scale and the Charlson scale were used to analyze comorbidities and to categorize patients into groups based on degree of risk for postoperative complications or death.
The postoperative (30-day) mortality rate was 2.9%, and the postoperative complications index was 44%. Prolonged air leakage was the most common complication (in 20.6%). The univariate analysis revealed that gender, age, smoking, neoadjuvant therapy and diabetes all had a significant impact on the incidence of complications. The factors found to be predictive of complications were body mass index (23.8 +/- 4.4), forced expiratory volume in one second (74.1 +/- 24%) and the ratio between forced expiratory volume in one second and forced vital capacity (0.65 +/- 0.1). The scales employed proved efficacious in the identification of the risk groups, as well as in drawing correlations with morbidity and mortality (p = 0.001 and p < 0.001). In the multivariate analysis, body mass index and the Charlson index were found to be the principal determinants of complications. In addition, prolonged air leakage was found to be the principal factor involved in mortality (p = 0.01).
Reductions in forced expiratory volume in one second, in the ratio between forced expiratory volume in one second and forced vital capacity, and in body mass index, as well as a Charlson score of 3 or 4 and a Torrington-Henderson score of 3, were associated with a greater number of postoperative complications in patients submitted to lobectomy for the treatment of bronchial carcinoma. Air leakage was found to be strongly associated with mortality.
分析合并症对接受肺叶切除术治疗支气管癌患者术后结局的影响。
对493例接受肺叶切除术治疗支气管癌的患者进行回顾性研究，其中305例患者符合纳入最终研究样本的标准。所有病例采用的手术技术相似。使用托灵顿 - 亨德森量表和查尔森量表分析合并症，并根据术后并发症或死亡风险程度将患者分组。
术后（30天）死亡率为2.9%，术后并发症指数为44%。持续性漏气是最常见的并发症（20.6%）。单因素分析显示，性别、年龄、吸烟、新辅助治疗和糖尿病均对并发症发生率有显著影响。发现可预测并发症的因素为体重指数（23.8±4.4）、一秒用力呼气量（74.1±24%）以及一秒用力呼气量与用力肺活量之比（0.65±0.1）。所采用的量表在识别风险组以及与发病率和死亡率建立相关性方面被证明是有效的（p = 0.001和p < 0.001）。多因素分析中，体重指数和查尔森指数被发现是并发症的主要决定因素。此外，持续性漏气被发现是导致死亡的主要因素（p = 0.01）。
对于接受肺叶切除术治疗支气管癌的患者，一秒用力呼气量、一秒用力呼气量与用力肺活量之比以及体重指数的降低，以及查尔森评分为3或4和托灵顿 - 亨德森评分为3，与更多的术后并发症相关。漏气被发现与死亡率密切相关。
