Department of Surgery, Division of Thoracic Surgery, McGill University Health Center, Montreal, QC, Canada.
J Am Coll Surg. 2011 Jun;212(6):1027-32. doi: 10.1016/j.jamcollsurg.2011.03.010. Epub 2011 Apr 13.
The high rate of prolonged air leak (PAL) after pulmonary resection has prompted interest in surgical adjuncts designed to prevent this complication. However, these adjuncts are costly and might not be beneficial if used routinely. Identification of patients at highest risk might allow for more effective use of these adjuncts. Therefore, we sought to develop a simple scoring system to predict PAL.
A derivation set of 580 patients was identified from a prospectively entered database of consecutive pulmonary resections at a single institution from 2002 to 2007. Patient and operative characteristics were compared using Student's t-test and chi-square tests. Significant variables on univariate analysis were entered into a stepwise logistic regression to establish a simple predictive model to estimate the risk of PAL. This scoring system was then validated in a consecutive set of 381 patients operated at the same institution from 2007 to 2009.
The rate of PAL was 14% in the derivation set and 18% in the validation set. Poor pulmonary function (forced expiratory volume in 1 second and carbon monoxide diffusing capacity, percent predicted) and pleural adhesions were significantly associated with PAL in the derivation set. A weighted scoring system was devised using pleural adhesions (+2 points), forced expiratory volume in 1 second (+1 per 10% below 100%), and carbon monoxide diffusing capacity (+1 per 20% below 100%). Total number of points estimated the probability of PAL. Hosmer-Lemeshow goodness-of-fit test confirmed validity (p > 0.2) of this scoring system in the validation set.
We have devised and validated a simple scoring system to predict the probability of PAL after pulmonary resection.
肺切除术后持续性肺漏气（PAL）发生率高，促使人们对旨在预防这种并发症的手术辅助手段产生兴趣。然而，这些辅助手段成本高昂，如果常规使用，可能不一定有益。识别风险最高的患者可能会更有效地使用这些辅助手段。因此，我们试图开发一种简单的评分系统来预测 PAL。
从 2002 年至 2007 年在一家机构前瞻性录入的连续肺切除术数据库中确定了一个 580 例患者的推导组。使用学生 t 检验和卡方检验比较患者和手术特点。单变量分析中的显著变量被纳入逐步逻辑回归，以建立一个简单的预测模型来估计 PAL 的风险。然后在同一机构于 2007 年至 2009 年进行的连续 381 例患者的验证组中验证了该评分系统。
推导组的 PAL 发生率为 14%，验证组为 18%。推导组中，肺功能差（1 秒用力呼气量和一氧化碳弥散量，预计百分比）和胸膜粘连与 PAL 显著相关。使用胸膜粘连（+2 分）、1 秒用力呼气量（每低于 100% 10%减少 1 分）和一氧化碳弥散量（每低于 100% 20%减少 1 分），设计了一个加权评分系统。总分数估计 PAL 的可能性。Hosmer-Lemeshow 拟合优度检验证实了该评分系统在验证组中的有效性（p > 0.2）。
我们已经设计并验证了一种简单的评分系统，以预测肺切除术后 PAL 的概率。
