Analysis of Risk Factors for Pulmonary Complications after Esophageal Cancer Surgeries_West China Medical Journal

Authors：

HUANG XiaoBo ,  LI ChunLing

ICU, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;

Corresponding author：

LI ChunLing, Email: drhuangxb@163.com

Keywords：

食管癌; 肺部并发症; 危险因素; 营养支持; 新辅助化学疗法

Video：

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目的　评估对降低食管癌术后患者肺部并发症发生的预防措施。方法　采用logistic回归的统计学方法，对胸外科1组2008年1月－2011年12月间行食管癌手术的109例患者进行回顾性分析，对所有可能的影响因素纳入研究。结果　共计有24例患者发生肺部并发症（包括肺炎、急性呼吸窘迫综合征）；计算体质量指数测定值，累计有31例患者术前存在营养不良体质量指数测定值＜18 kg/m2，其中有11例发生肺部并发症。吸烟和糖尿病是发生肺部并发症的独立危险因素（P=0.017，0.048），34名患者进行了新辅助化学疗法（化疗），未明显增加术后肺部并发症的风险（P=0.080）。术中限制液体输入的患者，术后肺部并发症明显减少（P=0.008）。结论　术前患者存在营养不良、吸烟史、糖尿病史及术中输入较多液体等都是患者发生肺部并发症的高危因素，但新辅助化疗未见引起肺部并发症升高。

Citation： HUANG XiaoBo,LI ChunLing. Analysis of Risk Factors for Pulmonary Complications after Esophageal Cancer Surgeries. West China Medical Journal, 2012, 27(9): 1338-1341. doi: Copy

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2.	Avendano CE, Flume PA, Silvestri GA, et al. Pulmonary complications after esophagectomy[J]. Ann Thorac Surg, 2002, 73(3): 922-926.
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10.	Ferguson MK, Celauro AD, Prachand V. Prediction of major pulmonary complications after esophagectomy[J]. Ann Thorac Surg, 2011, 91(5): 1494-1501.
11.	刘秀珍, 柯山, 高君, 等. 大创伤手术围术期液体管理的基本要素和原则[J].中国临床医生, 2012, 40(3): 163-167.
12.	Sihag S, Wright CD, Wain JC, et al. Comparison of perioperative outcomes following open versus minimally invasive Ivor Lewis oesophagectomy at a single, high-volume centre[J]. Eur J Cardiothorac Surg, 2012, 42(3): 430-437.
13.	Futier E, Roubin E, Jabaudon M , et al. Central venous O2 saturation and venous-to-arterial CO2 difference as complementary tools for goal-directed therapy during high-risk surgery[J]. Crit Care, 2010, 14(5): 193.
14.	Haverkort EB, Binnekade JM, de Haan RJ, et al. Suboptimal intake of nutrients after esophagectomy with gastric tube reconstruction[J]. J Acad Nutr Diet, 2012, 112(7): 1080-1087.
15.	黎介寿. 应激病人的代谢与营养支持[J]. 外科理论与实践, 2000, 5(2): 70-72.
16.	冯希源, 王玉琼, 罗碧如, 等. 围手术期营养支持在胃癌患者中的应用[J].华西医学, 2012, 27(2): 317-319.
17.	万献尧, 马小春. 实用危重症学[M]. 北京: 人民卫生出版社, 2008: 249-251.

1. 　McCulloch P, Ward J, Tekkis PP，et al. Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study[J]. BMJ, 2003, 327(7425): 1192-1197.
2. 　Avendano CE, Flume PA, Silvestri GA, et al. Pulmonary complications after esophagectomy[J]. Ann Thorac Surg, 2002, 73(3): 922-926.
3. 　Ferguson MK, Durkin AE. Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer[J]. J Thorac Cardiovasc Surg, 2002, 123(4): 661-668.
4. 　Michelet P, D’Journo XB, Roch A, et al. Protective ventilation influences systemic inflammation after esophagectomy[J]. Anesthesiology, 2006, 105(5): 911-919.
5. 　Ng JM. Update on anesthetic management for esophagectomy[J]. Curr Opin Anesthesiol, 2011, 24(1): 37-43.
6. 　吴阶平, 裘法祖, 吴孟超, 等. 黄家驷外科学[M]. 7版. 北京: 人民卫生出版社, 2010: 585-586.
7. 　陈春明. 国际生命科学学会中国办事处中国肥胖问题工作组联合数据汇总分析协作组. 中国成人体质指数分类的推荐意见简介[J]. 中华预防医学杂志, 2001, 35(5): 349-350.
8. 　中华医学会呼吸病学分会. 医院获得性肺炎诊断和治疗指南(草案)[J]. 中华结核和呼吸杂志, 1999, 22(4): 201.
9. 　Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination[J]. Am J Respir Crit Care Med, 1994, 149 (3 Pt 1): 818-824.
10. 　Ferguson MK, Celauro AD, Prachand V. Prediction of major pulmonary complications after esophagectomy[J]. Ann Thorac Surg, 2011, 91(5): 1494-1501.
11. 　刘秀珍, 柯山, 高君, 等. 大创伤手术围术期液体管理的基本要素和原则[J].中国临床医生, 2012, 40(3): 163-167.
12. 　Sihag S, Wright CD, Wain JC, et al. Comparison of perioperative outcomes following open versus minimally invasive Ivor Lewis oesophagectomy at a single, high-volume centre[J]. Eur J Cardiothorac Surg, 2012, 42(3): 430-437.
13. 　Futier E, Roubin E, Jabaudon M , et al. Central venous O2 saturation and venous-to-arterial CO2 difference as complementary tools for goal-directed therapy during high-risk surgery[J]. Crit Care, 2010, 14(5): 193.
14. 　Haverkort EB, Binnekade JM, de Haan RJ, et al. Suboptimal intake of nutrients after esophagectomy with gastric tube reconstruction[J]. J Acad Nutr Diet, 2012, 112(7): 1080-1087.
15. 　黎介寿. 应激病人的代谢与营养支持[J]. 外科理论与实践, 2000, 5(2): 70-72.
16. 　冯希源, 王玉琼, 罗碧如, 等. 围手术期营养支持在胃癌患者中的应用[J].华西医学, 2012, 27(2): 317-319.
17. 　万献尧, 马小春. 实用危重症学[M]. 北京: 人民卫生出版社, 2008: 249-251.

West China Medical Journal

Analysis of Risk Factors for Pulmonary Complications after Esophageal Cancer Surgeries

Abstract Full text Figures/Tables Video References Cited by

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