肺癌患者行钕：钇铝石榴石激光切除术术后早期并发症的独立临床危险因素

Patient-related independent clinical risk factors for early complications following Nd: YAG laser resection of lung cancer.

机构信息

Department for Interventional Pulmonology, Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Put Doktora, Goldmana 4, Sremska Kamenica, Serbia.

出版信息

Ann Thorac Med. 2012 Oct;7(4):233-7. doi: 10.4103/1817-1737.102184.

DOI:10.4103/1817-1737.102184

PMID:23189101

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3506104/

Abstract

INTRODUCTION

Neodymium:yttrium aluminum garnet (Nd:YAG) laser resection is one of the most established interventional pulmonology techniques for immediate debulking of malignant central airway obstruction (CAO). The major aim of this study was to investigate the complication rate and identify clinical risk factors for complications in patients with advanced lung cancer.

METHODS

In the period from January 2006 to January 2011, data sufficient for analysis were identified in 464 patients. Nd:YAG laser resection due to malignant CAO was performed in all patients. The procedure was carried out in general anesthesia. Complications after laser resection were defined as severe hypoxemia, global respiratory failure, arrhythmia requiring treatment, hemoptysis, pneumothorax, pneumomediastinum, pulmonary edema, tracheoesophageal fistulae, and death. Risk factors were defined as acute myocardial infarction within 6 months before treatment, hypertension, chronic arrhythmia, chronic obstructive pulmonary disease (COPD), stabilized cardiomyopathy, previous external beam radiotherapy, previous chemotherapy, and previous interventional pulmonology treatment.

RESULTS

There was 76.1% male and 23.9% female patients in the study, 76.5% were current smokers, 17.2% former smokers, and 6.3% of nonsmokers. The majority of patients had squamous cell lung cancer (70%), small cell lung cancer was identified in 18.3%, adenocarcinoma in 3.4%, and metastases from lung primary in 8.2%. The overall complication rate was 8.4%. Statistically significant risk factors were age (P = 0.001), current smoking status (P = 0.012), arterial hypertension (P < 0.0001), chronic arrhythmia (P = 0.034), COPD (P < 0.0001), and stabilized cardiomyopathy (P < 0.0001). Independent clinical risk factors were age over 60 years (P = 0.026), arterial hypertension (P < 0.0001), and COPD (P < 0.0001).

CONCLUSION

Closer monitoring of patients with identified risk factors is advisable prior and immediately after laser resection. In order to avoid or minimize complications, special attention should be directed toward patients who are current smokers, over 60 years of age, with arterial hypertension or COPD.

摘要

介绍

钕：钇铝石榴石（Nd：YAG）激光切除术是介入性肺病学中最成熟的技术之一，可立即消除恶性中央气道阻塞（CAO）。本研究的主要目的是调查并发症发生率，并确定晚期肺癌患者发生并发症的临床危险因素。

方法

在 2006 年 1 月至 2011 年 1 月期间，对 464 例患者进行了充分的数据分析。所有患者均因恶性 CAO 行 Nd：YAG 激光切除术。该手术在全身麻醉下进行。激光切除术后的并发症定义为严重低氧血症、全身呼吸衰竭、需要治疗的心律失常、咯血、气胸、纵隔气肿、肺水肿、气管食管瘘和死亡。危险因素定义为治疗前 6 个月内急性心肌梗死、高血压、慢性心律失常、慢性阻塞性肺疾病（COPD）、稳定型心肌病、外照射放疗、化疗和介入性肺病学治疗史。

结果

研究中有 76.1%的男性和 23.9%的女性患者，76.5%为现吸烟者，17.2%为前吸烟者，6.3%为不吸烟者。大多数患者患有鳞状细胞肺癌（70%），18.3%为小细胞肺癌，3.4%为腺癌，8.2%为肺部原发性转移。总的并发症发生率为 8.4%。有统计学意义的危险因素是年龄（P=0.001）、现吸烟状况（P=0.012）、动脉高血压（P<0.0001）、慢性心律失常（P=0.034）、COPD（P<0.0001）和稳定型心肌病（P<0.0001）。独立的临床危险因素是年龄超过 60 岁（P=0.026）、动脉高血压（P<0.0001）和 COPD（P<0.0001）。