Analysis of risk factors for pulmonary complications in patients with spontaneous pneumothorax after micro single-port video-assisted thoracoscopic surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 YUAN Jinquan , WANG Xiaokang , HUANG Zixuan

Department of Cardiothoracic Surgery, Songshan Lake Central Hospital of Dongguan City, Dongguan, 523323, Guangdong, P. R. China;

Corresponding author：

YUAN Jinquan, Email: hongxiping1@163.com

Keywords：

Spontaneous pneumothorax; single-port; video-assisted thoracoscopic surgery; postoperative pulmonary complications; risk factors

DOI：

10.7507/1007-4848.202008029

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Objective To analyze the occurrence of postoperative pulmonary complications (PPC) and the risk factors in patients with spontaneous pneumothorax who underwent micro single-port video-assisted thoracoscopic surgery (VATS).Methods A total of 158 patients with spontaneous pneumothorax who underwent micro single-port VATS in our hospital from April 2017 to December 2019 were retrospectively included, including 99 males and 59 females, with an average age of 40.53±9.97 years. The patients were divided into a PPC group (n=21) and a non-PPC group (n=137) according to whether PPC occurred after the operation, and the risk factors for the occurrence of PPC were analyzed.Results All 158 patients successfully completed the micro single-port VATS, and there was no intraoperative death. The postoperative chest tightness, chest pain, and dyspnea symptoms basically disappeared. During the postoperative period, there were 3 patients of pulmonary infection, 7 patients of atelectasis, 4 patients of pulmonary leak, 6 patients of pleural effusion, 1 patient of atelectasis and pleural effusion, and the incidence of PPC was 13.29% (21/158). Multivariate logistic regression analysis showed that lung disease [OR=32.404, 95%CI (2.717, 386.452), P=0.006], preoperative albumin level≤35 g/L [OR=14.912, 95%CI (1.719, 129.353), P=0.014], severe pleural adhesions [OR=26.023, 95%CI (3.294, 205.557), P=0.002], pain grade Ⅱ-Ⅲ 24 hours after the surgery [OR=64.024, 95%CI (3.606, 1 136.677), P=0.005] , age [OR=1.195, 95%CI (1.065, 1.342), P=0.002], intraoperative blood loss [OR=1.087, 95%CI (1.018, 1.162), P=0.013] were the risk factors for PPC after micro single-port VATS.Conclusion There is a close relationship between PPC after micro single-port VATS and perioperative indexes in patients with spontaneous pneumothorax. Clinically, targeted prevention and treatment can be implemented according to the age, pulmonary disease, preoperative albumin level, intraoperative blood loss, degree of pleural adhesion and pain grading 24 hours after surgery.

Citation： YUAN Jinquan, WANG Xiaokang, HUANG Zixuan. Analysis of risk factors for pulmonary complications in patients with spontaneous pneumothorax after micro single-port video-assisted thoracoscopic surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(2): 194-199. doi: 10.7507/1007-4848.202008029 Copy

1.	周益民, 刘永京. 微小单孔VATS治疗老年原发性气胸及术后血清TNF-α、IL-1、hs-CRP的变化. 新疆医科大学学报, 2020, 43(2): 208-211.
2.	Daemen JHT, Lozekoot PWJ, Maessen JG, et al. Chest tube drainage versus video-assisted thoracoscopic surgery for a first episode of primary spontaneous pneumothorax: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2019, 56(5): 819-829.
3.	Kaufmann KB, Loop T, Heinrich S, et al. Risk factors for post-operative pulmonary complications in lung cancer patients after video-assisted thoracoscopic lung resection: Results of the German Thorax Registry. Acta Anaesthesiol Scand, 2019, 63(8): 1009-1018.
4.	Cossu A, Martin Rother MD, Kusmirek JE, et al. Imaging early postoperative complications of cardiothoracic surgery. Radiol Clin North Am, 2020, 58(1): 133-150.
5.	王天佑, 胸外科围手术期肺保护中国专家共识(2019版)专家组, 中国医学基金会胸外科专业委员会. 胸外科围手术期肺保护中国专家共识(2019版). 中国胸心血管外科临床杂志, 2019, 26(9): 835-842.
6.	肖鹏, 张晓, 靳超. 电视胸腔镜手术下应用切割缝合器和缝扎术治疗自发性气胸患者的疗效分析. 中国内镜杂志, 2018, 24(4): 46-50.
7.	张胜强, 张洪艳, 王晴, 等. 双肺通气经乳晕单孔胸腔镜治疗男性自发性气胸. 中国微创外科杂志, 2018, 18(1): 82-83.
8.	Karcioglu O, Topacoglu H, Dikme O, et al. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med, 2018, 36(4): 707-714.
9.	辛少伟, 王涛, 辛向兵, 等. 电视胸腔镜治疗创伤性血胸后并发症发生的危险因素分析. 中华创伤杂志, 2020, 36(7): 619-623.
10.	Li X, Wang X, Zhang H, et al. Unilateral single-port thoracoscopic surgery for bilateral pneumothorax or pulmonary bullae. J Cardiothorac Surg, 2019, 14(1): 71.
11.	周静, 孙仲涛, 陈晓. 单孔胸腔镜手术与传统胸腔镜手术在自发性气胸治疗中的疗效观察. 中华全科医学, 2018, 16(8): 1279-1282.
12.	Ye Z, Zhang B, Chen Y, et al. Comparison of single utility port video-assisted thoracoscopic surgery (VATS) and three-port VATS for non-small cell lung cancer. Oncol Lett, 2019, 18(2): 1311-1317.
13.	李晓明, 杨广义, 张艳峰, 等. 胸腔镜治疗自发性气胸患者肺部并发症的相关因素分析. 临床肺科杂志, 2018, 23(3): 501-503, 507.
14.	Li X, Chen C, Wei X, et al. Retrospective comparative study on postoperative pulmonary complications after orthotopic liver transplantation using the melbourne group scale (MGS-2) diagnostic criteria. Ann Transplant, 2018, 23(1): 377-386.
15.	Numata T, Nakayama K, Fujii S, et al. Risk factors of postoperative pulmonary complications in patients with asthma and COPD. BMC Pulm Med, 2018, 18(1): 4.
16.	Li P, Li J, Lai Y, et al. Perioperative changes of serum albumin are a predictor of postoperative pulmonary complications in lung cancer patients: A retrospective cohort study. J Thorac Dis, 2018, 10(10): 5755-5763.
17.	Chen Y, Wu G, Wang R, et al. Preoperative albumin level serves as a predictor for postoperative pulmonary complications following elective laparoscopic gastrectomy. Curr Pharm Des, 2018, 24(27): 3250-3255.
18.	梁吉振, 韩孔启, 宫心明, 等. 3种胸腔镜微创术式治疗肺大疱价值比较. 安徽医学, 2018, 39(10): 1232-1235.
19.	杨震, 闫天生, 彭京平. 自发性气胸的电视胸腔镜手术治疗进展. 中国胸心血管外科临床杂志, 2018, 25(8): 724-727.
20.	彭珊, 程小敏. 手术室术中保温对老年股骨骨折患者出血量、体温及术后凝血功能的影响. 血栓与止血学, 2019, 25(1): 145-147.
21.	刘宗昂, 张苏宁. 人工气胸下胸腔镜在胸腺瘤切除术中的应用. 中国医科大学学报, 2019, 48(5): 461-463.
22.	Matsumoto R, Takamori S, Yokoyama S, et al. Lung function in the late postoperative phase and influencing factors in patients undergoing pulmonary lobectomy. J Thorac Dis, 2018, 10(5): 2916-2923.
23.	李仁鹏, 黎琰, 胡文滕, 等. 无管化单孔胸腔镜肺大疱切除术治疗自发性气胸18例. 中国微创外科杂志, 2019, 19(10): 942-944.
24.	康珀铭. 单孔胸腔镜肺大疱切除术治疗自发性气胸的疗效及中期随访研究. 基因组学与应用生物学, 2019, 38(7): 3376-3382.
25.	Shalhub S, Neptune E, Sanchez DE, et al. Spontaneous pneumothorax and hemothorax frequently precede the arterial and intestinal complications of vascular Ehlers-Danlos syndrome. Am J Med Genet A, 2019, 179(5): 797-802.

1. 周益民, 刘永京. 微小单孔VATS治疗老年原发性气胸及术后血清TNF-α、IL-1、hs-CRP的变化. 新疆医科大学学报, 2020, 43(2): 208-211.
2. Daemen JHT, Lozekoot PWJ, Maessen JG, et al. Chest tube drainage versus video-assisted thoracoscopic surgery for a first episode of primary spontaneous pneumothorax: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2019, 56(5): 819-829.
3. Kaufmann KB, Loop T, Heinrich S, et al. Risk factors for post-operative pulmonary complications in lung cancer patients after video-assisted thoracoscopic lung resection: Results of the German Thorax Registry. Acta Anaesthesiol Scand, 2019, 63(8): 1009-1018.
4. Cossu A, Martin Rother MD, Kusmirek JE, et al. Imaging early postoperative complications of cardiothoracic surgery. Radiol Clin North Am, 2020, 58(1): 133-150.
5. 王天佑, 胸外科围手术期肺保护中国专家共识(2019版)专家组, 中国医学基金会胸外科专业委员会. 胸外科围手术期肺保护中国专家共识(2019版). 中国胸心血管外科临床杂志, 2019, 26(9): 835-842.
6. 肖鹏, 张晓, 靳超. 电视胸腔镜手术下应用切割缝合器和缝扎术治疗自发性气胸患者的疗效分析. 中国内镜杂志, 2018, 24(4): 46-50.
7. 张胜强, 张洪艳, 王晴, 等. 双肺通气经乳晕单孔胸腔镜治疗男性自发性气胸. 中国微创外科杂志, 2018, 18(1): 82-83.
8. Karcioglu O, Topacoglu H, Dikme O, et al. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med, 2018, 36(4): 707-714.
9. 辛少伟, 王涛, 辛向兵, 等. 电视胸腔镜治疗创伤性血胸后并发症发生的危险因素分析. 中华创伤杂志, 2020, 36(7): 619-623.
10. Li X, Wang X, Zhang H, et al. Unilateral single-port thoracoscopic surgery for bilateral pneumothorax or pulmonary bullae. J Cardiothorac Surg, 2019, 14(1): 71.
11. 周静, 孙仲涛, 陈晓. 单孔胸腔镜手术与传统胸腔镜手术在自发性气胸治疗中的疗效观察. 中华全科医学, 2018, 16(8): 1279-1282.
12. Ye Z, Zhang B, Chen Y, et al. Comparison of single utility port video-assisted thoracoscopic surgery (VATS) and three-port VATS for non-small cell lung cancer. Oncol Lett, 2019, 18(2): 1311-1317.
13. 李晓明, 杨广义, 张艳峰, 等. 胸腔镜治疗自发性气胸患者肺部并发症的相关因素分析. 临床肺科杂志, 2018, 23(3): 501-503, 507.
14. Li X, Chen C, Wei X, et al. Retrospective comparative study on postoperative pulmonary complications after orthotopic liver transplantation using the melbourne group scale (MGS-2) diagnostic criteria. Ann Transplant, 2018, 23(1): 377-386.
15. Numata T, Nakayama K, Fujii S, et al. Risk factors of postoperative pulmonary complications in patients with asthma and COPD. BMC Pulm Med, 2018, 18(1): 4.
16. Li P, Li J, Lai Y, et al. Perioperative changes of serum albumin are a predictor of postoperative pulmonary complications in lung cancer patients: A retrospective cohort study. J Thorac Dis, 2018, 10(10): 5755-5763.
17. Chen Y, Wu G, Wang R, et al. Preoperative albumin level serves as a predictor for postoperative pulmonary complications following elective laparoscopic gastrectomy. Curr Pharm Des, 2018, 24(27): 3250-3255.
18. 梁吉振, 韩孔启, 宫心明, 等. 3种胸腔镜微创术式治疗肺大疱价值比较. 安徽医学, 2018, 39(10): 1232-1235.
19. 杨震, 闫天生, 彭京平. 自发性气胸的电视胸腔镜手术治疗进展. 中国胸心血管外科临床杂志, 2018, 25(8): 724-727.
20. 彭珊, 程小敏. 手术室术中保温对老年股骨骨折患者出血量、体温及术后凝血功能的影响. 血栓与止血学, 2019, 25(1): 145-147.
21. 刘宗昂, 张苏宁. 人工气胸下胸腔镜在胸腺瘤切除术中的应用. 中国医科大学学报, 2019, 48(5): 461-463.
22. Matsumoto R, Takamori S, Yokoyama S, et al. Lung function in the late postoperative phase and influencing factors in patients undergoing pulmonary lobectomy. J Thorac Dis, 2018, 10(5): 2916-2923.
23. 李仁鹏, 黎琰, 胡文滕, 等. 无管化单孔胸腔镜肺大疱切除术治疗自发性气胸18例. 中国微创外科杂志, 2019, 19(10): 942-944.
24. 康珀铭. 单孔胸腔镜肺大疱切除术治疗自发性气胸的疗效及中期随访研究. 基因组学与应用生物学, 2019, 38(7): 3376-3382.
25. Shalhub S, Neptune E, Sanchez DE, et al. Spontaneous pneumothorax and hemothorax frequently precede the arterial and intestinal complications of vascular Ehlers-Danlos syndrome. Am J Med Genet A, 2019, 179(5): 797-802.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of risk factors for pulmonary complications in patients with spontaneous pneumothorax after micro single-port video-assisted thoracoscopic surgery

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