腹腔镜肝切除术后肺部并发症的危险因素：一项多中心回顾性分析。
Risk factors for pulmonary complications after laparoscopic liver resection: a multicenter retrospective analysis.
作者信息
Wang Hanyu, Xing Ruyi, Li Xiaohong, Cai Ning, Tan Mengyuan, Shen Meijun, Li Min, Wang Qiufeng, Wang Jizhou, Gao Chen, Luan Yuanhang, Zhang Min, Xie Yanhu
机构信息
Department of Anaesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China.
Department of Anaesthesiology, The First Affiliated Hospital of Bengbu Medical Collage, Bengbu, China.
出版信息
Surg Endosc. 2023 Jan;37(1):510-517. doi: 10.1007/s00464-022-09490-6. Epub 2022 Aug 24.
BACKGROUND
Postoperative pulmonary complications (PPCs) are among the most common complications after liver resection. Although the application of laparoscopy has reduced the incidence of PPCs, the rate of PPCs after laparoscopic liver resection (LLR) remains high and the risk factors for the same are unclear. Therefore, this study aimed to determine the risk factors for PPCs after LLR.
METHODS
In this multicenter study, 296 patients underwent LLR from January 2019 to December 2020. Demographic data, pathological variables, and perioperative variables were reviewed. Univariate and multivariate analyses were performed to identify the independent risk factors for PPCs.
RESULTS
Of the 296 patients, 80 (27.0%) developed PPCs. Patients with PPCs had significantly increased total costs, operation costs, length of stays, and postoperative hospital stays. Multivariate analysis identified three independent risk factors for PPCs after LLR: smoking [Odds ratio (OR): 5.413, 95% confidence intervals (CI): 2.446-11.978, P = < 0.001], location of lesion in segment 7 or 8 (OR 3.134, 95% CI 1.593-6.166, P = 0.001), duration of liver ischemia (OR 1.038, 95% CI 1.022-1.054, P < 0.001), and presence of intraoperative hypothermia (OR 3.134, 95% CI 1.593-6.166, P < 0.001).
CONCLUSION
Smoking, location of lesion in segment 7 or 8, duration of liver ischemia and intraoperative hypothermia were independent risk factors for PPCs which significantly increased the length of stays and burden of healthcare costs.
背景
术后肺部并发症（PPCs）是肝切除术后最常见的并发症之一。尽管腹腔镜的应用降低了PPCs的发生率，但腹腔镜肝切除术（LLR）后PPCs的发生率仍然很高，且其危险因素尚不清楚。因此，本研究旨在确定LLR后PPCs的危险因素。
方法
在这项多中心研究中，296例患者在2019年1月至2020年12月期间接受了LLR。回顾了人口统计学数据、病理变量和围手术期变量。进行单因素和多因素分析以确定PPCs的独立危险因素。
结果
296例患者中，80例（27.0%）发生了PPCs。发生PPCs的患者总费用、手术费用、住院时间和术后住院时间显著增加。多因素分析确定了LLR后PPCs的三个独立危险因素：吸烟[比值比（OR）：5.413，95%置信区间（CI）：2.446 - 11.978，P = ＜0.001]、病变位于7段或8段（OR 3.134，95% CI 1.593 - 6.166，P = 0.001）、肝脏缺血持续时间（OR 1.038，95% CI 1.022 - 1.054，P ＜0.001）和术中体温过低（OR 3.134，95% CI 1.593 - 6.166，P ＜0.001）。
结论
吸烟、病变位于7段或8段、肝脏缺血持续时间和术中体温过低是PPCs的独立危险因素，这些因素显著增加了住院时间和医疗费用负担。
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