Matsumi Akihiro, Takenaka Ryuta, Ando Chihiro, Sato Yuki, Takei Kensuke, Yasutomi Eriko, Okanoue Shotaro, Oka Shohei, Kawai Daisuke, Kataoka Junro, Takemoto Koji, Tsugeno Hirofumi, Fujiki Shigeatsu, Kawahara Yoshiro
Department of Gastroenterology, Tsuyama Chuo Hospital, 1756, Kawasaki, Tsuyama, 708-0841, Japan.
Department of Endoscopy, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
Dig Dis Sci. 2017 Nov;62(11):3084-3090. doi: 10.1007/s10620-017-4750-4. Epub 2017 Sep 6.
ESD allows higher rates of en-bloc and R0 resections, but has occasionally complications such as aspiration pneumonia. Factors associated with aspiration pneumonia are not completely understood.
To analyze the relationship between aspiration pneumonia and preoperative factors including pulmonary function tests.
A total of 978 patients with gastric tumors who had received pulmonary function tests were treated by ESD between June 2006 and May 2014. Pulmonary function tests were assessed using a spirometer. The patients were categorized into four groups according to the predicted vital capacity (%VC) and forced expiratory volume in 1 s as a percentage of forced vital capacity (FEV1.0%): normal; restrictive pulmonary dysfunction; obstructive; and mixed. The factors associated with aspiration pneumonia were retrospectively analyzed.
Among the 268 cases with abnormal pulmonary function, 10 cases (3.7%) developed aspiration pneumonia. On the other hand, 7 cases (1.0%) with normal pulmonary function developed pneumonia. There was a significant correlation between pulmonary function and aspiration pneumonia (p = 0.010). When the pulmonary function cases were stratified into subgroups, 2.5% of cases with obstructive pulmonary dysfunction developed pneumonia, 5.5% with restrictive and 5.3% with mixed. By logistic regression analysis, pulmonary function, the presence of cerebral vascular disease, and procedure time were identified as significant independent risk factors associated with aspiration pneumonia. The odds ratios for pulmonary function, cerebral vascular disease, and procedure time were 3.6, 5.1, and 5.2, respectively.
Preoperative pulmonary function tests may be useful markers to evaluate the risk for aspiration pneumonia after gastric ESD.
内镜黏膜下剥离术（ESD）可实现更高的整块切除率和R0切除率，但偶尔会出现诸如吸入性肺炎等并发症。与吸入性肺炎相关的因素尚未完全明确。
分析吸入性肺炎与包括肺功能测试在内的术前因素之间的关系。
2006年6月至2014年5月期间，共有978例接受了肺功能测试的胃肿瘤患者接受了ESD治疗。使用肺活量计评估肺功能测试。根据预测肺活量（%VC）和第1秒用力呼气量占用力肺活量的百分比（FEV1.0%）将患者分为四组：正常；限制性肺功能障碍；阻塞性；和混合性。对与吸入性肺炎相关的因素进行回顾性分析。
在268例肺功能异常的病例中，10例（3.7%）发生了吸入性肺炎。另一方面，7例（1.0%）肺功能正常的患者发生了肺炎。肺功能与吸入性肺炎之间存在显著相关性（p = 0.010）。当将肺功能病例分层为亚组时，2.5%的阻塞性肺功能障碍病例发生了肺炎，5.5%的限制性肺功能障碍病例和5.3%的混合性肺功能障碍病例发生了肺炎。通过逻辑回归分析，肺功能、脑血管疾病的存在和手术时间被确定为与吸入性肺炎相关的显著独立危险因素。肺功能、脑血管疾病和手术时间的优势比分别为3.6、5.1和5.2。
术前肺功能测试可能是评估胃ESD术后吸入性肺炎风险的有用指标。
