Factors of persistent cough secondary to thoracoscopic resection of lung cancer

doi:10.3969/j.issn.2096-8493.2021.01.008

Abstract

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

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

Figures/Tables 6

References 15

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因素		CAP组(163例)				非CAP组(407例)			χ²值		P值
因素		例数		构成比(%)		例数		构成比(%)	χ²值		P值
性别									2.653		0.103
男		71		25.45		208		74.55
女		92		31.62		199		68.38
年龄(岁)									5.671		0.017
<60		109		32.34		228		67.66
≥60		54		23.18		179		76.82
吸烟史									5.757		0.016
无		91		33.33		182		66.67
有		72		24.24		225		75.76
BMI									5.179		0.023
<24.28		77		24.68		235		75.32
≥24.28		86		33.33		172		66.67
手术侧									11.174		0.001
右侧		113		33.93		220		66.07
左侧		50		21.10		187		78.90
手术肺叶									12.826		0.001
上叶		117		34.11		226		65.89
非上叶		46		20.26		181		79.74
麻醉时间(min)									7.510		0.006
≥196.36		71		35.68		128		64.32
<196.36		92		24.80		279		75.20
气管周围淋巴结									5.226		0.022
清扫		157		29.85		369		70.15
未清扫		6		13.64		38		86.36
因素	CAP组(163例)				非CAP组(407例)				χ²值	P值
因素	例数		构成比(%)		例数		构成比(%)		χ²值	P值
病理类型									3.422	0.331
腺癌	140		29.98		327		70.02
鳞癌	14		26.42		39		73.58
小细胞癌	3		21.43		11		78.57
其他	6		16.67		30		83.33
术后并发胸腔积液和(或)气胸									5.329	0.021
是	52		36.11		92		63.89
否	111		26.06		315		73.94

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