Gates Margaret A, Feskanich Diane, Speizer Frank E, Hankinson Susan E
Department of Medicine, Bridham and Women's Hospital and Harvard Medical School, Channing Laboratory, Third Floor, 181 Longwood Avenue, Boston, MA 02115, USA.
Scand J Work Environ Health. 2007 Apr;33(2):140-7. doi: 10.5271/sjweh.1117.
Smoke generated during laser surgery and electrocautery contains respiratory irritants and human carcinogens. Although laboratory and animal studies have demonstrated that this smoke has inflammatory and mutagenic potential, no population-based studies of the health effects of exposure to surgical smoke have been published. We examined the association between duration of employment as an operating room nurse, a proxy measure for surgical smoke exposure, and subsequent lung cancer risk.
This study was conducted among 86 747 women in the Nurses' Health Study. Information on the duration of prior operating room employment was collected in 1984, and the women were followed for incident, confirmed lung cancer. Cox proportional hazards regression was used to model the incidence rate ratio of lung cancer for each exposure category using women with no prior operating room employment for comparison. All of the models were adjusted for age, smoking history, passive smoke exposure, fruit and vegetable consumption, and alpha carotene and lycopene intake.
A history of operating room employment was not associated with an increased rate of lung cancer in multivariable analyses [rate ratio (RR) 0.99, 95% confidence interval (95% CI) 0.86-1.15]. In fact, nurses in the highest exposure category, > or =15 years of operating room employment, had a significantly lower rate of lung cancer than nurses with no prior operating room employment (RR 0.58, 95% CI 0.37-0.91), possibly due to confounding by overall health status or residual confounding by smoking history.
Long-term exposure to surgical smoke, as measured by the duration of operating room employment, does not appear to increase the risk of lung cancer.
激光手术和电灼过程中产生的烟雾含有呼吸道刺激物和人类致癌物。尽管实验室和动物研究表明这种烟雾具有炎症和诱变潜力，但尚未发表基于人群的手术烟雾暴露对健康影响的研究。我们研究了作为手术室护士的工作时长（手术烟雾暴露的替代指标）与随后患肺癌风险之间的关联。
本研究在护士健康研究中的86747名女性中进行。1984年收集了她们之前在手术室工作时长的信息，并对这些女性随访观察新发确诊肺癌情况。采用Cox比例风险回归模型，以无手术室工作经历的女性作为对照，对每个暴露类别下肺癌的发病率比进行建模。所有模型均根据年龄、吸烟史、被动吸烟暴露、水果和蔬菜摄入量以及α-胡萝卜素和番茄红素摄入量进行了调整。
在多变量分析中，有手术室工作经历与肺癌发病率增加无关[发病率比（RR）0.99，95%置信区间（95%CI）0.86 - 1.15]。事实上，暴露程度最高组（手术室工作≥15年）的护士患肺癌的几率显著低于无手术室工作经历的护士（RR 0.58，95%CI 0.37 - 0.91），这可能是由于总体健康状况的混杂或吸烟史的残余混杂所致。
以手术室工作时长衡量的长期手术烟雾暴露似乎不会增加患肺癌的风险。
