肺裂完整性程度对电视辅助胸腔镜肺癌肺叶切除术后主要院内结局的影响：一项回顾性队列研究
Effects of degree of pulmonary fissure completeness on major in-hospital outcomes after video-assisted thoracoscopic lung cancer lobectomy: a retrospective-cohort study.
作者信息
Li Shuangjiang, Wang Zhiqiang, Zhou Kun, Wang Yan, Wu Yanming, Li Pengfei, Che Guowei
机构信息
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu.
Department of Thoracic Surgery, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing University, Chongqing China.
出版信息
Ther Clin Risk Manag. 2018 Mar 2;14:461-474. doi: 10.2147/TCRM.S159632. eCollection 2018.
BACKGROUND
To evaluate the clinical significance of degree of pulmonary fissure completeness (PFC) on major in-hospital outcomes following video-assisted thoracoscopic (VATS) lobectomy for non-small-cell lung cancer (NSCLC).
MATERIALS AND METHODS
We carried out a single-center retrospective analysis on the prospectively maintained database at our unit between August 2014 and October 2015. Patients were divided into two groups based on their fissure sum average (FSA). Patients with FSA >1 (1< FSA ≤3) were considered to have incomplete pulmonary fissures (group A), while patients with FSA of 0-1 were considered to have complete pulmonary fissures (group B). Demographic differences in perioperative characteristics and surgical outcomes between these two groups were initially assessed. Then, a multivariate logistic-regression analysis was further conducted to identify the independent predictors for major in-hospital outcomes.
RESULTS
A total of 563 patients undergoing VATS lobectomy for NSCLC were enrolled. There were 190 patients in group A and 373 patients in group B. The overall morbidity and mortality rates of our cohort were 30.6% and 0.5%, respectively. Group A patients had a significantly higher overall morbidity rate than group B patients (42.1% vs 24.7%, <0.001). Both minor morbidity (40.5% vs 22%, <0.001) and major morbidity (11.1% vs 5.6%, =0.021) rates in group A patients were also significantly higher than group B patients. No significant difference was observed in mortality rate between these two groups (1.1% vs 0.3%, =0.26). The incomplete degree of PFC was significantly correlated with length of stay and chest-tube duration (log-rank <0.001) after surgery. Finally, the incomplete degree of PFC was found to be predictive of overall morbidity (OR 2.08, <0.001), minor morbidity (OR 2.39, <0.001), and major morbidity (OR 2.06, =0.031) by multivariate logistic-regression analyses.
CONCLUSION
Degree of PFC is an excellent categorical predictor for both major and minor morbidity after VATS lobectomy for NSCLC.
背景
评估肺裂完整性（PFC）程度对非小细胞肺癌（NSCLC）电视辅助胸腔镜（VATS）肺叶切除术后主要院内结局的临床意义。
材料与方法
我们对2014年8月至2015年10月期间本单位前瞻性维护的数据库进行了单中心回顾性分析。根据肺裂总和平均值（FSA）将患者分为两组。FSA>1（1<FSA≤3）的患者被认为肺裂不完整（A组），而FSA为0-1的患者被认为肺裂完整（B组）。首先评估这两组患者围手术期特征和手术结局的人口统计学差异。然后，进一步进行多因素逻辑回归分析以确定主要院内结局的独立预测因素。
结果
共有563例行VATS肺叶切除术治疗NSCLC的患者入组。A组190例患者，B组373例患者。我们队列的总体发病率和死亡率分别为30.6%和0.5%。A组患者的总体发病率显著高于B组患者（42.1%对24.7%，<0.001）。A组患者的轻微发病率（分别为40.5%对22%，<0.001）和严重发病率（分别为11.1%对5.6%，=0.021）也显著高于B组患者。两组之间的死亡率未观察到显著差异（1.1%对0.3%，=0.26）。PFC的不完整程度与术后住院时间和胸管留置时间显著相关（对数秩检验<0.001）。最后，通过多因素逻辑回归分析发现PFC的不完整程度可预测总体发病率（比值比2.08，<0.001）、轻微发病率（比值比2.39，<0.001）和严重发病率（比值比2.06，=0.031）。
结论
PFC程度是NSCLC患者VATS肺叶切除术后主要和轻微发病率的优秀分类预测指标。
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