Tajima Yuki, Tsuruta Masashi, Yahagi Masashi, Hasegawa Hirotoshi, Okabayashi Koji, Shigeta Kohei, Ishida Takashi, Kitagawa Yuko
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Jpn J Clin Oncol. 2017 Sep 1;47(9):815-819. doi: 10.1093/jjco/hyx082.
Spirometry is a basic test that provides much information about pulmonary function; it is performed preoperatively in almost all patients undergoing colorectal cancer (CRC) surgery in our hospital. However, the value of spirometry as a preoperative test for CRC surgery remains unknown. The aim of this study was to determine whether spirometry is useful to predict postoperative complications (PCs) after CRC surgery.
The medical records of 1236 patients who had preoperative spirometry tests and underwent CRC surgery between 2005 and 2014 were reviewed. Preoperative spirometry results, such as forced vital capacity (FVC), one-second forced expiratory volume (FEV1), %VC (FVC/predicted VC) and FEV1/FVC (%FEV1), were analyzed with regard to PCs, including pneumonia.
PCs were found in 383 (30.9%) patients, including 218 (56%) with surgical site infections, 67 (17%) with bowel obstruction, 62 (16%) with leakage and 20 (5.2%) with pneumonia. Of the spirometry results, %VC was correlated with PC according to logistic regression analysis (odds ratio, OR = 0.99, 95% confidence interval, CI = 0.98-0.99; P = 0.034). Multivariate analysis after adjusting for male sex, age, laparoscopic surgery, tumor location, operation time and blood loss showed that a lower %VC tends to be a risk factor for PC (OR = 0.99, 95% CI = 0.98-1.002; P = 0.159) and %VC was an independent risk factor for postoperative pneumonia in PCs (OR = 0.97, 95% CI = 0.94-0.99; P = 0.049).
In CRC surgery, %VC may be a predictor of postoperative complications, especially pneumonia.
肺活量测定是一项能提供大量肺功能信息的基本检查；在我院，几乎所有接受结直肠癌（CRC）手术的患者术前都会进行此项检查。然而，肺活量测定作为CRC手术术前检查的价值仍不明确。本研究的目的是确定肺活量测定是否有助于预测CRC手术后的术后并发症（PCs）。
回顾了2005年至2014年间1236例术前进行肺活量测定并接受CRC手术患者的病历。分析术前肺活量测定结果，如用力肺活量（FVC）、一秒用力呼气量（FEV1）、%VC（FVC/预测肺活量）和FEV1/FVC（%FEV1）与包括肺炎在内的PCs之间的关系。
383例（30.9%）患者出现PCs，其中218例（56%）发生手术部位感染，67例（17%）发生肠梗阻，62例（16%）发生渗漏，2例（5.2%）发生肺炎。根据逻辑回归分析，肺活量测定结果中，%VC与PC相关（比值比，OR = 0.99，95%置信区间，CI = 0.98 - 0.99；P = 0.034）。在对男性、年龄、腹腔镜手术、肿瘤位置、手术时间和失血量进行校正后的多变量分析显示，较低的%VC往往是PC的危险因素（OR = 0.99，95% CI = 0.98 - 1.002；P = 0.159），且%VC是PCs中术后肺炎的独立危险因素（OR = 0.97，95% CI = 0.94 - 0.99；P = 0.049）。
在CRC手术中，%VC可能是术后并发症尤其是肺炎的预测指标。
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