Increased risk of aspiration and pulmonary complications after lung resection in head and neck cancer patients
Increased risk of aspiration and pulmonary complications after lung resection in head and neck cancer patients
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DOI：
10.1016/j.athoracsur.2006.06.018
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发表时间：
2006-12-01
影响因子：
4.6
通讯作者：
Mehran, Reza J.
中科院分区：
文献类型：
--
作者：
Herrera, Luis J.;Correa, Arlene M.;Mehran, Reza J.
背景头颈部癌症（HNC）患者的吞咽和气道保护可能受损。尚未评估HNC患者肺切除术后肺部并发症的风险。因此，我们回顾了肺切除术后HNC患者发生抽吸相关肺部并发症的风险。回顾性分析了从一家机构前瞻性收集的数据库，确定了1997年至2004年因疑似原发性肺癌接受肺切除术的1633例患者。其中，76例患者有HNC病史。其余1557例患者被定义为对照组。分类变量采用卡方检验进行分析。单因素和多因素Logistic回归分析确定肺切除术后吸入性肺炎的相关变量。HNC组7例（9.2%）发生吸入性肺炎，对照组10例（0.6%）发生吸入性肺炎（p < 0.001）。在整个肺切除术人群中，HNC病史（p < 0.001;比值比（OR），17.5; 95%置信区间（CI），6.0 - 50.6）和术后喉返神经麻痹（p < 0.001; OR，27.8; 95% CI，5.2 - 148）是肺切除术后吸入性肺炎的独立危险因素。吸入性肺炎患者的住院时间较长，中位数为30天（范围，10 - 258）与6天（范围，0 - 374; p = 0.021）。在HNC患者中，既往喉返神经麻痹可预测吸入性肺炎（p = 0.034; OR，8.8; 95%CI，1.1至65.4）。HNC患者在肺切除术后发生吸入性肺炎的风险增加。在肺切除术前对HNC患者进行吞咽功能评估以识别吸入，以避免与吸入性肺炎相关的发病率和住院时间延长。
Background. Patients with head and neck cancers (HNCs) may have impaired deglutition and airway protection. The risk of pulmonary complications after lung resection has not been evaluated in HNC patients. We therefore reviewed the risk of aspiration-related pulmonary complications in HNC patients after pulmonary resection.Methods. Retrospective review of a prospectively collected database from a single institution identified 1633 patients who underwent pulmonary resection for suspected primary lung cancer from 1997 to 2004. Of these, 76 patients had a history of HNC. The remaining 1557 patients were defined as controls. Categoric variables were analyzed with the chi(2) test. Univariate and multivariate logistic regression analyses determined the variables related to aspiration pneumonia after pulmonary resection.Results. Aspiration pneumonia occurred in 7 HNC patients (9.2%) versus 10 patients (0.6%) in the control group (p < 0.001). In the entire population with pulmonary resection, HNC history (p < 0.001; odds ratio (OR), 17.5; 95% confidence interval (CI), 6.0 to 50.6), and postoperative recurrent laryngeal nerve paralysis (p < 0.001; OR, 27.8; 95% CI, 5.2 to 148) were independent risk factors for aspiration pneumonia after pulmonary resection. Length of stay was longer in patients with aspiration pneumonia, with a median of 30 days ( range, 10 to 258) versus 6 days (range, 0 to 374; p = 0.021). In the HNC patients, prior recurrent laryngeal nerve paralysis was predictive of aspiration pneumonia (p = 0.034; OR, 8.8; 95% CI, 1.1 to 65.4).Conclusions. Patients with HNC have an increased risk of aspiration pneumonia after pulmonary resection. Evaluation of swallowing function to identify aspiration is indicated in HNC patients before pulmonary resection to avoid the morbidity and prolonged hospitalization associated with aspiration pneumonia.