肺癌经胸腔镜切除术后继发持续性咳嗽的影响因素分析

doi:10.3969/j.issn.2096-8493.2021.01.008

摘要/Abstract

摘要：

目的研究肺癌患者经胸腔镜行肺叶切除术后出现持续性咳嗽(cough after pulmonary resection,CAP)的影响因素。方法回顾性分析2017年4月至2019年10月河南省人民医院胸外科收治的570例肺癌手术患者(入选CAP组163例,入选非CAP组407例)的临床资料,包括性别、年龄、体质量指数(BMI)、吸烟史、手术侧(左侧和右侧)、手术肺叶部位(上叶和非上叶)、麻醉时间、是否清扫气管周围淋巴结、病理类型、术后是否并发胸腔积液和(或)气胸,分别采用单因素和多因素logistic回归分析发生CAP的影响因素。结果 570例肺癌手术患者中,CAP的发生率为28.60%(163/570)。单因素分析显示,年龄<60岁、BMI≥24.28、无吸烟史、右侧手术、上叶手术、麻醉时间≥196.36min、清扫气管周围淋巴结、术后并发胸腔积液和(或)气胸的肺癌患者术后发生CAP的占比分别为32.34%(109/337)、33.33%(86/258)、33.33%(91/273)、33.93%(113/333)、34.11%(117/343)、35.68%(71/199)、29.85%(157/526)、36.11%(52/144),明显高于年龄≥60岁、BMI<24.28、有吸烟史、左侧手术、非上叶手术、麻醉时间<196.36min、未清扫气管周围淋巴结、术后未并发胸腔积液和(或)气胸的患者[占比分别为23.18%(54/233)、24.68%(77/312)、24.24%(72/297)、21.10%(50/237)、20.26%(46/227)、24.80%(92/371)、13.64%(6/44)、26.06%(111/426)],差异均有统计学意义(χ²值分别为5.671、5.179、5.757、11.174、12.826、7.510、5.226、5.329,P值分别为0.017、0.023、0.016、0.001、0.001、0.006、0.022、0.021)。多因素logistic回归分析显示,年龄≥60岁(以<60岁为参照,OR=0.616,95%CI: 0.424~0.895)、有吸烟史(以无吸烟史为参照,OR=0.656,95%CI: 0.432~0.997)为CAP发生的保护因素;BMI<24.28(以≥24.28为参照,OR=1.814,95%CI: 1.241~2.652)、右侧手术(以左侧为参照,OR=3.601,95%CI: 1.695~7.561)、上叶手术(以非上叶手术为参照,OR=1.114,95%CI: 1.020~1.217)、麻醉时间≥196.36min(以<196.36min为参照,OR=1.789,95%CI: 1.214~2.636)、清扫气管周围淋巴结(以未清扫为参照,OR=2.730,95%CI: 1.126~6.622)为CAP发生的危险因素。结论年龄<60岁、BMI<24.28、无吸烟史、右侧手术、上叶手术、麻醉时间≥196.36min、术中清扫气管周围淋巴结的患者术后出现CAP的风险较高。

关键词: 肺肿瘤, 胸腔镜, 手术后并发症, 咳嗽, 因素分析, 统计学

Abstract:

Objective To study the factors of persistent cough after pulmonary resection (CAP) in patients with lung cancer after thoracoscopic lobectomy. Methods A retrospective analysis had been conducted with clinical data of 570 patients (163 cases in CAP group and 407 cases in non-CAP group) with lung cancer who underwent surgery in the Department of Thoracic Surgery of He’nan Provincial People’s Hospital from April 2017 to October 2019, including gender, age, BMI, smoking history, surgical side (left or right), surgical lobe site (upper lobe or not), anesthesia time, dissected peritracheal lymph nodes, pathological types, postoperative pleural effusion and/or pneumothorax. The factors of CAP were examined through univariable and multivariable logistic regression. Results The occurrence rate of CAP was 28.60% (163/570) among 570 lung cancer surgery patients. Univariable analysis showed that the occurrence rates of CAP among patients with age <60 years, BMI ≥24.28, no smoking history, right surgical side, upper lobe surgery, anesthesia time ≥196.36 min, no peritracheal lymph node dissection and without postoperative pleural effusion/pneumothorax (32.34% (109/337), 33.33% (86/258), 33.33% (91/273), 33.93% (113/333), 34.11% (117/343), 35.68% (71/199), 29.85% (157/526), 36.11% (52/144)) were higher than those with age ≥60 years, BMI<24.28, smoking history, left side surgery, surgery outside upper lobe, anesthesia time <196.36 min, peritracheal lymph node dissection and postoperative pleural effusion/pneumothorax (23.18% (54/233), 24.68% (77/312), 24.24% (72/297), 21.10% (50/237), 20.26% (46/227), 24.80% (92/371), 13.64% (6/44) and 26.06% (111/426)). The differences were statistically significant (χ² values were 5.671, 5.179, 5.757, 11.174, 12.826, 7.510, 5.226 and 5.329, respectively, P values were 0.017, 0.023, 0.016, 0.001, 0.001, 0.006, 0.022 and 0.021, respectively). Multivariable logistic regression analysis showed that age ≥60 years (OR=0.616, 95%CI: 0.424-0.895) and smoking history (OR=0.656, 95%CI: 0.432-0.997) were protective factors for CAP; BMI<24.28 (reference: BMI ≥24.28; OR=1.814, 95%CI: 1.241-2.652) and right side surgery (reference: left; OR=3.601, 95%CI: 1.695-7.561), upper lobe surgery (reference: outside upper lobe; OR=1.114, 95%CI: 1.020-1.217), anesthesia time ≥196.36 min (reference: <196.36 min; OR=1.789, 95%CI: 1.214-2.636), and peritracheal lymph node dissection (reference: no dissection, OR=2.730, 95%CI: 1.126-6.622) were risk factors of CAP. Conclusion Patients with age <60 years, BMI<24.28, no smoking history, right side surgery, upper lobe surgery, anesthesia time ≥196.36 min, and peritracheal lymph node dissection have higher risk of CAP after surgery.

Key words: Lung neoplasms, Thoracoscopes, Postoperative complications, Cough, Factor analysis, statistical

辛五群, 陈晓, 汤金星, 徐高俊, 周振强, 何苡. 肺癌经胸腔镜切除术后继发持续性咳嗽的影响因素分析[J]. 结核与肺部疾病杂志, 2021, 2(1): 31-37. doi: 10.3969/j.issn.2096-8493.2021.01.008

XIN Wu-qun, CHEN Xiao, TANG Jin-xing, XU Gao-jun, ZHOU Zhen-qiang, HE Yi. Factors of persistent cough secondary to thoracoscopic resection of lung cancer[J]. Journal of Tuberculosis and Lung Disease, 2021, 2(1): 31-37. doi: 10.3969/j.issn.2096-8493.2021.01.008

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参考文献 15

[1]	马书梅, 刘瑞娟, 张影影. 肺癌的流行病学. 世界最新医学信息文摘, 2019,19(26):77-78, 80. doi: 10.19613/j.cnki.1671-3141.2019.26.035.
[2]	Sawabata N, Maeda H, Takeda S, et al. Persistent cough following pulmonary resection: observational and empiric study of possible causes. Ann Thorac Surg, 2005,79(1):289-293. doi: 10.1016/j.athoracsur.2004.06.045. doi: 10.1016/j.athoracsur.2004.06.045 URL pmid: 15620960
[3]	Sawada S, Suehisa H, Yamashita M. Inhalation of corticosteroid and β-agonist for persistent cough following pulmonary resection. Gen Thorac Cardiovasc Surg, 2012,60(5):285-288. doi: 10.1007/s11748-011-0910-1. doi: 10.1007/s11748-011-0910-1 URL pmid: 22453538
[4]	贺大璞, 王元星, 韦兵, 等. 薇乔线间断缝合法处理支气管残端的临床效果. 实用预防医学, 2009,16(3):826-827. doi: 10.3969/j.issn.1006-3110.2009.03.081.
[5]	Gao YH, Guan WJ, Xu G, et al. Validation of the Mandarin Chinese version of the Leicester Cough Questionnaire in bronchiectasis. Int J Tuberc Lung Dis, 2014,18(12):1431-1437. doi: 10.5588/ijtld.14.0195. doi: 10.5588/ijtld.14.0195 URL pmid: 25517807
[6]	Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest, 1997,111(6):1718-1723. doi: 10.1378/chest.111.6.1718. doi: 10.1378/chest.111.6.1718 URL pmid: 9187199
[7]	Darling GE, Allen MS, Decker PA, et al. lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg, 2011,141(3):662-670. doi: 10.1016/j.jtcvs.2010.11.008. doi: 10.1016/j.jtcvs.2010.11.008 URL pmid: 21335122
[8]	王鑫, 支修益. 国际肺癌研究协会(IASLC)第八版肺癌TNM分期解读. 中华胸部外科电子杂志, 2016,3(2):70-76. doi: 10.3877/cma.j.issn.2095-8773.2016.02.002.
[9]	陈如冲, 刘春丽, 罗炜, 等. 慢性咳嗽常见病因之间咳嗽敏感性的差异. 中国呼吸与危重监护杂志, 2013,12(4):384-389. doi: 10.7507/1671-6205.20130092.
[10]	Polverino M, Polverino F, Fasolino M, et al. Anatomy and neuro-pathophysiology of the cough reflex arc. Multidiscip Respir Med, 2012,7(1):5. doi: 10.1186/2049-6958-7-5. doi: 10.1186/2049-6958-7-5 URL pmid: 22958367
[11]	Sarna L, Evangelista L, Tashkin D, et al. Impact of respiratory symptoms and pulmonary function on quality of life of long-term survivors of non-small cell lung cancer. Chest, 2004,125(2):439-445. doi: 10.1378/chest.125.2.439. doi: 10.1378/chest.125.2.439 URL pmid: 14769722
[12]	Huang J, Luo Q, Tan Q, et al. Evaluation of the surgical fat-filling procedure in the treatment of refractory cough after systematic mediastinal lymphadenectomy in patients with right lung cancer. J Surg Res, 2014,187(2):490-495. doi: 10.1016/j.jss.2013.10.062. doi: 10.1016/j.jss.2013.10.062 URL
[13]	林嵘嘉, 车国卫, 徐志华, 等. 肺癌患者电视胸腔镜手术后咳嗽的影响因素分析:单中心前瞻性研究. 中国胸心血管外科临床杂志, 2017,24(10):748-752. doi: 10.7507/1007-4848.201704008.
[14]	Achilleos A. Evidence-based Evaluation and Management of Chronic Cough. Med Clin North Am, 2016,100(5):1033-1045. doi: 10.1016/j.mcna.2016.04.008. doi: 10.1016/j.mcna.2016.04.008 URL pmid: 27542423
[15]	慕腾, 姜冠潮, 李晓, 等. 胸腔镜肺切除术后持续咳嗽的多因素分析. 中国微创外科杂志, 2017,17(7):577-580. doi: 10.3969/j.issn.1009-6604.2017.07.001.

序号	变量名称	赋值说明	序号	变量名称	赋值说明
X₁	年龄	≥60岁=1,<60岁=0	X₆	手术肺叶部位	上叶手术=1,非上叶手术=0
X₂	BMI	<24.28=1,≥24.28=0	X₇	气管周围淋巴结清扫	是=1,否=0
X₃	吸烟史	有吸烟史=1,无吸烟史=0	X₈	术后并发胸腔积液和(或)气胸	是=1,否=0
X₄	麻醉时间	≥196.36min=1,<196.36min=0	Y	CAP	未发生CAP=0,发生CAP=1
X₅	手术侧	右侧手术=1,左侧手术=0

变量	β值	$S_\bar{x}$值	Wald χ²值	P值	OR值	95%CI值
年龄(岁)
<60^a					1
≥60	-0.484	0.191	6.466	0.011	0.616	0.424~0.895
吸烟史
无^a					1
有	-0.422	0.213	3.901	0.048	0.656	0.432~0.997
手术侧
左侧^a					1
右侧	1.281	0.384	11.104	0.026	3.601	1.695~7.561
手术肺叶
非上叶^a					1
上叶	0.108	0.045	5.739	0.016	1.114	1.020~1.217
气管周围淋巴结
未清扫^a					1
清扫	1.004	0.452	4.936	0.036	2.730	1.126~6.622
麻醉时间(min)
<196.36^a					1
≥196.36	0.582	0.198	8.633	0.037	1.789	1.214~2.636
BMI
≥24.28^a					1
<24.28	-0.438	0.195	5.032	0.025	1.814	1.241~2.652