Yuan Yang, Zhou Yu-Fei, Chen Wei, Shen Yi, Zhou Yun-Feng
Department of Thoracic Surgery, West China Fourth Hospital, Sichuan University, Chengdu 610041, China.
Department of Cardiology, Chengdu First People's Hospital, Chengdu 610093, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2022 May;53(3):488-492. doi: 10.12182/20220560108.
To explore the surgical safety of patients with comorbid non-small cell lung cancer (NSCLC) and pneumoconiosis.
In this study, the clinical data of 165 NSCLC patients treated at West China Fourth Hospital, Sichuan University from August 2019 to May 2021 were collected. Among them, 21 patients with comorbid pneumoconiosis were included in the pneumoconiosis group, and the remaining 144 patients were included in the general group. Radical resection for lung cancer was performed in both groups. The perioperative clinical data, including preoperative, intraoperative and postoperative indicators, of the two groups were compared and analyzed.
There was no perioperative death in either group. The proportions of male patients and patients with smoking history in the pneumoconiosis group were significantly higher than those in the general group ( <0.05). The body mass index (BMI), pulmonary ventilation function and diffusion function in the pneumoconiosis group were significantly lower than those in the general group ( <0.05). There was no significant difference in the median operative time and the median volume of intraoperative blood loss between the pneumoconiosis group and the general group. In the pneumoconiosis group, the proportion of advanced tumors (stage Ⅱ/Ⅲ), incidence of postoperative complications, median duration of postoperative intubation, and postoperative length of hospital stay were higher/longer than those of the normal group ( <0.05). Compared with the general group, the incidences of lymph node calcification, dense pleural adhesion and surgical method alteration (switching from thoracoscopic surgery to open surgery or video-assisted thoracoscopy) were also significantly higher in the pneumoconiosis group ( <0.05). Univariate analysis showed that age, smoking history, pneumoconiosis, pulmonary ventilation dysfunction, lymph node calcification, dense pleural adhesion and the volume of intraoperative blood loss were the risk factors for postoperative complications. Further multivariate regression analysis demonstrated that smoking history ( =1.37, <0.05), lymph node calcification ( =2.36, <0.05) and pulmonary ventilation dysfunction ( =5.21, <0.05) were independent risk factors for postoperative complications.
NSCLC patients with comorbid pneumoconiosis face relatively greater risks during the perioperative period when they undergo radical resection for lung cancer. Therefore, the close attention of surgeons and the nursing staff should be raised accordingly.
探讨合并尘肺病的非小细胞肺癌（NSCLC）患者的手术安全性。
本研究收集了2019年8月至2021年5月在四川大学华西第四医院接受治疗的165例NSCLC患者的临床资料。其中，21例合并尘肺病的患者纳入尘肺病组，其余144例患者纳入普通组。两组均行肺癌根治性切除术。比较并分析两组患者围手术期的临床资料，包括术前、术中和术后指标。
两组均无围手术期死亡病例。尘肺病组男性患者及有吸烟史患者的比例显著高于普通组（<0.05）。尘肺病组的体重指数（BMI）、肺通气功能和弥散功能显著低于普通组（<0.05）。尘肺病组与普通组的中位手术时间和术中失血量中位数无显著差异。尘肺病组中晚期肿瘤（Ⅱ/Ⅲ期）的比例、术后并发症发生率、术后插管中位时间和术后住院时间均高于/长于正常组（<0.05）。与普通组相比，尘肺病组淋巴结钙化、胸膜致密粘连及手术方式改变（从胸腔镜手术转为开放手术或电视辅助胸腔镜手术）的发生率也显著更高（<0.05）。单因素分析显示，年龄、吸烟史、尘肺病、肺通气功能障碍、淋巴结钙化、胸膜致密粘连和术中失血量是术后并发症的危险因素。进一步的多因素回归分析表明，吸烟史（=1.37，<0.05）、淋巴结钙化（=2.36，<0.05）和肺通气功能障碍（=5.21，<0.05）是术后并发症的独立危险因素。
合并尘肺病的NSCLC患者在接受肺癌根治性切除术时围手术期面临相对更大的风险。因此，外科医生和护理人员应相应提高密切关注度。
