Liu Fuqiang, Wen Qian, Yang Yiwen, Chen Jiahui, Jin Guangshan, Yu Ling, He Jianhua
Department of Anesthesiology, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China.
School of Anesthesiology, Xuzhou Medical University, Xuzhou, China.
J Thorac Dis. 2024 Jun 30;16(6):3623-3635. doi: 10.21037/jtd-24-197. Epub 2024 Jun 13.
Diaphragmatic dysfunction escalates the susceptibility to postoperative pulmonary complications (PPCs). Currently, no study reports the occurrence of diaphragmatic dysfunction correlated with PPCs following radical resection of esophageal cancer in aged patients. We aimed to diagnose diaphragmatic dysfunction via ultrasonography and analyze diaphragmatic dysfunction's relation with PPCs after radical resection of esophageal cancer surgery in aged patients.
This prospective observational study comprised 86 aged patients undergoing radical resection of esophageal cancer. Patient characteristics data and intraoperative details were collected. Ultrasonography was performed before (preoperative) and after (first, third, and fifth day postoperatively) surgery. Outcome measures included PPCs within seven days postoperative, occurrence of diaphragmatic dysfunction, and short-term prognosis.
After excluding 14 patients, we finally analyzed clinical data from 72 patients. The prevalence of PPCs was higher in the patients with diaphragmatic dysfunction than those without (19 of 23, 83% 21 of 49, 43%, P=0.004). Postoperative diaphragmatic dysfunction was positively correlated with PPCs in patients who underwent elective radical esophageal cancer surgery (r=0.37, P=0.001). Persistent diaphragmatic dysfunction, furthermore, was positively correlated with the development of multiple PPCs (r=0.43, P<0.001). The logistic regression analysis revealed that age, total open procedure, and postoperative diaphragmatic dysfunction were identified as significant risk factors for PPCs, while total open procedure was an independent risk factor for diaphragmatic dysfunction.
Postoperative diaphragmatic dysfunction positively correlates with developing PPCs. Continuous monitoring of postoperative diaphragmatic function can screen high-risk patients with PPCs, which has specific clinical significance. Age, total open procedure, and diaphragmatic dysfunction are identified as risk factors for developing PPCs, while total open procedure specifically increases the risk for postoperative diaphragmatic dysfunction.
膈肌功能障碍会增加术后肺部并发症（PPCs）的易感性。目前，尚无研究报道老年患者食管癌根治术后膈肌功能障碍与PPCs的发生情况。我们旨在通过超声诊断膈肌功能障碍，并分析老年患者食管癌根治术后膈肌功能障碍与PPCs的关系。
这项前瞻性观察性研究纳入了86例接受食管癌根治术的老年患者。收集患者的特征数据和术中详细情况。在手术前（术前）和手术后（术后第1天、第3天和第5天）进行超声检查。观察指标包括术后7天内的PPCs、膈肌功能障碍的发生情况以及短期预后。
排除14例患者后，我们最终分析了72例患者的临床数据。膈肌功能障碍患者的PPCs发生率高于无膈肌功能障碍的患者（23例中的19例，83%；49例中的21例，43%，P=0.004）。在接受择期食管癌根治术的患者中，术后膈肌功能障碍与PPCs呈正相关（r=0.37，P=0.001）。此外，持续性膈肌功能障碍与多种PPCs的发生呈正相关（r=0.43，P<0.001）。逻辑回归分析显示，年龄、全开放手术和术后膈肌功能障碍被确定为PPCs的重要危险因素，而全开放手术是膈肌功能障碍的独立危险因素。
术后膈肌功能障碍与PPCs的发生呈正相关。持续监测术后膈肌功能可以筛查出PPCs的高危患者，具有特定的临床意义。年龄、全开放手术和膈肌功能障碍被确定为发生PPCs的危险因素，而全开放手术尤其会增加术后膈肌功能障碍的风险。
