Acute lung injury following an esophagectomy for esophageal cancer, with special reference to the clinical factors and cytokine levels of peripheral blood and pleural drainage fluid
Acute lung injury following an esophagectomy for esophageal cancer, with special reference to the clinical factors and cytokine levels of peripheral blood and pleural drainage fluid
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DOI：
10.1111/j.1442-2050.2007.00725.x
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发表时间：
2008-01-01
影响因子：
2.6
通讯作者：
Maehara, Y.
中科院分区：
文献类型：
--
作者：
Morita, M.;Yoshida, R.;Maehara, Y.
急性肺损伤（ALI）是食管癌食管切除术后最严重的并发症之一。然而，ALI的发病机制仍不清楚。对27例接受扩大根治性食管切除术的患者进行了胸腔引流液和外周血细胞因子水平测定。比较11例ALI患者（I组）和16例非ALI患者（II组）的临床因素和细胞因子水平。行结肠间置术的患者发生ALI的频率高于行胃管重建术的患者（86% vs 25%，P = 0.009）。I组手术时间明显长于II组。Logistic回归分析显示结肠间置是ALI的独立危险因素（P < 0.05）。I组术后吻合口漏和全身炎症反应综合征（SIRS）的发生率高于II组（P < 0.01）。I组血清IL-6、IL-8水平均显著高于II组。IL-1 β和肿瘤坏死因子-α在外周血中检测不到，而在胸腔积液中检测到。I组胸水IL-1 β水平高于II组。总之，更大的手术压力，如更长的手术时间，因此被认为是与首次发作的ALI。因此，发生在胸外部位的不良事件，如吻合口周围坏死和局部感染可能是第二次发作。此外，ALI不仅可引起SIRS，还可引起其他并发症，如吻合口瘘。
Acute lung injury (ALI) is one of most serious complications to occur after an esophagectomy for esophageal cancer. However, the pathogenesis of ALI is still unclear. The cytokine levels of pleural drainage fluid as well as peripheral blood were measured in 27 patients who had undergone an extended radical esophagectomy. Both the clinical factors and cytokine levels were compared between 11 patients with (group I) and 16 without ALI (group II). ALI occurred more frequently in patients who underwent colon interposition than in those who received a gastric tube reconstruction (86% vs 25%, P = 0.009). The operation time of group I was significantly longer than that of group II. A logistic regression analysis revealed colon interposition to be an independent factor associated with the ALI (P < 0.05). Postoperative anastomotic leakage and systemic inflammatory response syndrome (SIRS) occurred more frequently in group I than in group II (P < 0.01). Both the serum interleukin-6 (IL-6) and IL-8 levels of group I were significantly higher than those of group II. IL-1 beta and tumor necrosis factor-alpha were undetectable in the peripheral blood, whereas they were detectable in the pleural effusion. The IL-1 beta of pleural effusion was higher in group I than group II. In conclusion, greater surgical stress, such as a longer operative time, is thus considered to be associated with the first attack of ALI. The adverse events developing in the extra-thoracic site, such as necrosis and local infection around anastomosis may therefore be the second attack. Furthermore, ALI may cause not only SIRS but also other complications such as anastomotic leakage.