Durmuş Yasin, Karalok Alper, Duru Çöteli Sinem Ayşe, Boran Nurettin, Ünsal Mehmet, Boyraz Gökhan, Turan Taner
University of Health Sciences Turkey, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey.
Turk J Obstet Gynecol. 2020 Dec;17(4):292-299. doi: 10.4274/tjod.galenos.2020.54781. Epub 2020 Dec 10.
To evaluate pulmonary morbidity related to diaphragm surgery performed for gynecological cancers and to identify the impact of transdiaphragmatic thoracotomy.
We reviewed clinical and pathologic data of 232 women who had undergone diaphragm surgery as a part of cytoreductive surgery procedures performed for gynecological cancers.
Transdiaphragmatic thoracotomy occurred in 52 patients (22.4%). Rate of pulmonary complications among patients who had a transdiaphragmatic thoracotomy was higher compared with patients who did not have a transdiaphragmatic thoracotomy (40.4% vs 20.6%, p=0.004). Transdiaphragmatic thoracotomy [odds ratio (OR), 2.66; 95% confidence interval (CI), 1.20-5.92; p=0.016], colon resection (OR, 5.21; 95% CI, 2.34-11.63; p<0.001), ileostomy (OR, 19.61; 95% CI, 1.64-250.0; p=0.019), and any extra-pulmonary complication occurrence (OR, 2.35; 95% CI, 1.13-4.88; p=0.023) were identified as independent predictors of pulmonary morbidity. Patients with transdiaphragmatic thoracotomy developed pleural effusion, pleural effusion necessitating drainage, pneumothorax, pneumonitis, and atelectasis more frequently compared with patients who did not have transdiaphragmatic thoracotomy. Rate of admission to postoperative intensive care of patients with transdiaphragmatic thoracotomy (30.8%) was significantly higher than that of patients without transdiaphragmatic thoracotomy (12.2%) (p=0.001).
Transdiaphragmatic thoracotomy is an independent predictor of pulmonary morbidity among patients who underwent diaphragm surgery. Avoiding accidental transdiaphragmatic thoracotomies with maximal attention and performing full-thickness resection procedures with alternative surgical techniques preventing a thoracotomy may help decrease pulmonary morbidity rates and postoperative care costs.
评估因妇科癌症行膈肌手术相关的肺部发病率，并确定经膈开胸手术的影响。
我们回顾了232例因妇科癌症行肿瘤细胞减灭术而接受膈肌手术的女性患者的临床和病理资料。
52例患者（22.4%）接受了经膈开胸手术。与未接受经膈开胸手术的患者相比，接受经膈开胸手术的患者肺部并发症发生率更高（40.4%对20.6%，p=0.004）。经膈开胸手术[比值比（OR），2.66；95%置信区间（CI），1.20 - 5.92；p=0.016]、结肠切除术（OR，5.21；95%CI，2.34 - 11.63；p<0.001）、回肠造口术（OR，19.61；95%CI，1.64 - 250.0；p=0.019）以及任何肺外并发症的发生（OR，2.35；95%CI，1.13 - 4.88；p=0.023）被确定为肺部发病的独立预测因素。与未接受经膈开胸手术的患者相比，接受经膈开胸手术的患者更频繁地出现胸腔积液、需要引流的胸腔积液、气胸、肺炎和肺不张。接受经膈开胸手术的患者术后入住重症监护病房的比例（30.8%）显著高于未接受经膈开胸手术的患者（12.2%）（p=0.001）。
经膈开胸手术是接受膈肌手术患者肺部发病的独立预测因素。在最大程度的关注下避免意外的经膈开胸手术，并采用替代手术技术进行全层切除手术以避免开胸，可能有助于降低肺部发病率和术后护理成本。
