全腔镜下食管癌根治术围手术期呼吸系统并发症发生的危险因素分析 [中文引用][英文引用]

 【摘要】 目的：探究全腔镜下食管癌根治术围手术期呼吸系统并发症发生的危险因素。方法：回顾性纳入2021年1月至2022年10月于河北医科大学第四医院行全腔镜下食管癌根治术的100例食管鳞癌患者作为研究对象，根据围手术期是否发生呼吸系统并发症将所有患者分为无并发症组（n =73）和并发症组（n =27）。汇总分析患者的基线资料和手术相关资料，应用单因素和多因素Logistic回归分析全腔镜下食管癌根治术围手术期发生呼吸系统并发症的独立危险因素。结果：行全腔镜下食管癌根治术的100例食管鳞癌患者中，有19例患者在围手术期发生呼吸系统并发症，其中包括10例气管、支气管损伤，9例声音嘶哑伴肺部感染。并发症组患者的性别、体重指数、病程、饮酒史、高血压史、肿瘤位置、病理分期、术中出血量、术中肋间神经阻滞、淋巴结清扫数目与无并发症组患者比较，差异无统计学意义（P＞0.05）；并发症组患者的年龄、吸烟史、术前合并糖尿病、术前合并慢性阻塞性肺疾病（COPD）、术中输液量、手术时间、术中胸腔粘连、术中喉返神经损伤与无并发症组比较，差异有统计学意义（P＜0.05）。多因素Logistic 回归分析结果显示，年龄≥65岁、有吸烟史、术前合并糖尿病、术前合并COPD、术中胸腔粘连、术中喉返神经损伤是全腔镜下食管癌根治术围手术期呼吸系统并发症发生的独立危险因素。结论：全腔镜下食管癌根治术围手术期发生呼吸系统并发症与年龄≥65岁、有吸烟史、术前合并糖尿病、术前合并COPD、术中胸腔粘连、术中喉返神经损伤等因素密切相关，可通过在围手术期进行雾化、控制血糖、术中注意神经保护等措施来更好地预防上述危险因素，减少围手术期呼吸系统并发症发生，改善患者的预后情况。

 [Abstract]  Objective  To exploring risk factors for perioperative respiratory complications in total laparoscopic radical esophagectomy for esophageal cancer. Methods  A total of 100 patients with squamous esophageal cancer who were underwent total laparoscopic radical esophageal cancer surgery in the Fourth Hospital of Hebei Medical University from January 2021 to October 2022 were retrospectively included as study subjects, and all patients were divided into no-complication group (n=73) and complication group (n=27) according to whether or not they developed respiratory complications during the perioperative period. The baseline and surgery-related data of the patients were pooled and analyzed, and unifactorial and multifactorial logistic regression were applied to analyze the independent risk factors for the occurrence of respiratory complications during the perioperative period of total laparoscopic radical esophageal cancer surgery. Results  Among the 100 patients with squamous esophageal cancer who were underwent total laparoscopic radical esophageal cancer surgery, 19 patients developed respiratory complications during the perioperative period, including 10 patients with tracheal and bronchial injuries, 9 patients with hoarseness accompanied by lung infections. There were no statistically significant differences in gender, body mass index, disease duration, history of alcohol consumption, history of hypertension, tumor location, pathological stage, intraoperative bleeding volume, intraoperative intercostal nerve block, and number of lymph node dissection between the complication group and the non-complication group (P>0.05). There were statistically significant differences in age, smoking history, preoperative diabetes mellitus, preoperative chronic obstructive pulmonary disease (COPD), intraoperative fluid infusion volume, operation time, intraoperative thoracic adhesion, and intraoperative recurrent laryngeal nerve injury between the complication group and the non-complication group (P<0.05). The results of multifactorial logistic regression analysis showed that age≥65 years, history of smoking, preoperative diabetes mellitus, preoperative COPD, intraoperative thoracic adhesions, and intraoperative recurrent laryngeal nerve injury were the independent risk factors for the occurrence of perioperative respiratory complications in total laparoscopic radical surgery for esophageal cancer. Conclusion  Perioperative respiratory complications during total laparoscopic radical surgery for esophageal cancer are closely related to age≥65 years, smoking history, preoperative diabetes mellitus, preoperative COPD, intraoperative thoracic adhesion, intraoperative recurrent laryngeal nerve injury. We can better prevent the above risk factors, reduce the occurrence of perioperative respiratory complications, and improve the prognosis of patients by performing nebulization, control of blood glucose levels, and neuroprotection during operation.