Analysis of pulmonary complications after three-field lymph node dissection for esophageal cancer
Analysis of pulmonary complications after three-field lymph node dissection for esophageal cancer
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DOI：
10.1016/s0003-4975(03)00549-6
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发表时间：
2003-09-01
影响因子：
4.6
通讯作者：
Daiko, H
中科院分区：
文献类型：
--
作者：
Fang, WT;Kato, H;Daiko, H
背景资料。肺部并发症是食道切除术后发病率和死亡率的主要组成部分，而扩大淋巴清扫术后的肺部并发症尚未得到很好的研究。对441例三野淋巴清扫术患者的临床资料进行回顾性分析。发生肺部并发症32例(7.3%)，死亡11例(占34.4%)，其中肺部并发症占全部死亡的62.4%。将肺部并发症分为原发肺部并发症(A组)和继发性肺部并发症(B组)，分别进行分析。比较两组围术期室内空气中动脉血气的变化。所有的原发并发症均发生在术后第1周，而次要并发症在术后平均分布。与A组相比，B组严重感染(60%比23.5%，p=0.041)和呼吸衰竭(70.6%比31.6%，p=0.045)的发生率显著增加，并伴随着更高的死亡率(47.1%比15.8%，p=0.047)。A、C两组动脉血气变化相似，B组PaO2、pH均降低，PaCO2升高。原发肺部并发症的独立危险因素为大手术史、肺功能异常和慢性肾功能不全。高龄、合并全胃切除、吻合口大漏、双侧声带麻痹是继发性肺部并发症的预测因素。肺部并发症可维持在较低水平，但仍是三野淋巴清扫术后死亡的主要原因。原发和继发肺部并发症是两个不同的实体，应该采取不同的处理方式。室内空气中的动脉血气有助于肺部并发症的处理。(C)2003年，由胸外科医生学会提供。
Background. Pulmonary complications are a major component of morbidity and mortality after esophagectomy, and have not been well studied after extended lymphadenectomy.Methods. Four hundred forty-one patients underwent three-field lymph node dissection and were retrospectively reviewed. Pulmonary complications developed in 32 patients (7.3%) and resulted in 11 deaths (34.4% of pulmonary complications were fatal, and 62.4% of all mortality was caused by pulmonary complications). Pulmonary complications were divided into primary (group A) and secondary pulmonary morbidities (group B), and analyzed separately. Perioperative arterial blood gases on room air were compared with a matched control group (group C).Results. All primary complications occurred in the first postoperative week, whereas secondary complications were distributed evenly after operation. The incidence of serious infection (60% versus 23.5%, p = 0.041) and respiratory failure (70.6% versus 31.6%, p = 0.045) was significantly higher in group B as compared with group A and was associated with a higher death rate (47.1% versus 15.8%, p = 0.047). Changes in arterial blood gases were similar in groups A and C, both PaO2 and pH were reduced in group B, and PaCO2 was increased. Independent risk factors for primary pulmonary complications were history of major operation, abnormal spirometry, and chronic renal dysfunction. Predictive factors for secondary pulmonary complications were old age, concomitant total gastrectomy, major anastomotic leakage, and bilateral vocal cord palsy.Conclusions. Pulmonary complications can be kept at a low level, but they still account for most of the mortality after three-field lymph node dissection. Primary and secondary pulmonary complications are two distinct entities that should be managed differently. Arterial blood gases on room air are helpful in the management of pulmonary complications. (C) 2003 by The Society of Thoracic Surgeons.