Qualitative Analysis of Preoperative High-Resolution Computed Tomography: Risk Factors for Pulmonary Complications After Major Lung Resection.
Qualitative Analysis of Preoperative High-Resolution Computed Tomography: Risk Factors for Pulmonary Complications After Major Lung Resection.
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术前高分辨率计算机断层扫描的定性分析：主要肺切除术后肺部并发症的危险因素。
DOI：
10.1016/j.athoracsur.2015.09.009
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发表时间：
2015
期刊：
影响因子：
4.6
通讯作者：
et al.
中科院分区：
文献类型：
--
作者：
Takahashi Y;Matsuda M;et al.
背景大肺切除术后肺部并发症与死亡率密切相关。高分辨率计算机断层扫描（HRCT）上的肺气肿、支气管扩张和支气管壁增厚的定性表现是慢性阻塞性肺疾病的指标，并可能作为肺部并发症的危险因素。方法研究对象为2010年5月至2014年12月连续接受肺恶性肿瘤单叶切除术的347例患者。采用多因素logistic回归回顾性分析肺部并发症与术前临床因素和HRCT结果的相关性。分析使用报告为危险因素的临床变量来比较肺部并发症的预测能力。 结果发生肺部并发症的患者男性较多（p < 0.001），吸烟史较多（p < 0.001），类固醇使用率较低（p < 0.001），HRCT 上肺气肿更常见（p < 0.001），HRCT 上支气管扩张更常见（p = 0.002），HRCT 上更常见的支气管壁增厚（p < 0.001），以及更高的扩大切除率（p = 0.006）。在多变量分析中，HRCT结果（比值比[OR] 12.01，95%置信区间[CI]：5.582至25.83，p<0.001）和扩大切除（OR 7.726，95% CI：1.678至35.57，p= 0.009）是肺部并发症的独立危险因素。在匹配有和没有肺部并发症的患者之间的危险因素后，肺气肿（OR 3.394，95% CI：1.781至6.469，p < 0.001）和支气管壁增厚（OR 6.250，95% CI：2.414至16.18，p < 0.001）与模型中的肺部并发症独立相关。结论HRCT 的定性结果是肺叶切除术后肺部并发症的独立危险因素。术前 HRCT 可能有助于预测肺部并发症。
BackgroundPostoperative pulmonary complications after major lung resection are strongly associated with mortality. Qualitative findings of emphysema, bronchiectasis, and bronchial wall thickening on high-resolution computed tomography (HRCT) are indicators of chronic obstructive pulmonary disease and may serve as risk factors for pulmonary complications.MethodsThe subjects were 347 consecutive patients who underwent single lobectomy for pulmonary malignancy from May 2010 to December 2014. Correlations of pulmonary complications with preoperative clinical factors and HRCT findings were retrospectively examined using multivariate logistic regression analysis to compare the predictive ability for pulmonary complications using clinical variables that were reported to be risk factors.ResultsPatients who had pulmonary complications were more frequently male (p< 0.001), with a greater smoking history (p< 0.001), lower rate of steroid use (p< 0.001), more frequent emphysema on HRCT (p< 0.001), more frequent bronchiectasis on HRCT (p= 0.002), more frequent bronchial wall thickening on HRCT (p< 0.001), and higher rate of extended resection (p= 0.006). In multivariate analysis, HRCT findings (odds ratio [OR] 12.01, 95% confidence interval [CI]: 5.582 to 25.83,p< 0.001) and extended resection (OR 7.726, 95% CI: 1.678 to 35.57,p= 0.009) were independent risk factors for pulmonary complications. After matching of risk factors between patients with and without pulmonary complication, emphysema (OR 3.394, 95% CI: 1.781 to 6.469,p< 0.001) and bronchial wall thickening (OR 6.250, 95% CI: 2.414 to 16.18,p< 0.001) were independently associated with pulmonary complications in the model with better performance.ConclusionsQualitative findings on HRCT are independent risk factors for pulmonary complications after lobectomy. Preoperative HRCT may be useful to predict pulmonary complications.