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目的回顾性分析肺癌患者术后发生支气管胸膜瘘(BPF)的临床危险因素。方法对639例接受手术的肺癌病例进行统计并通过单因素及Logistic回归模型分析其危险因素。结果21例患者术后发生BPF(男性20例,女性1例),发生率为3.3%(21/639)。其中6例患者死亡,病死率为28.6%。单因素分析中BPF的临床危险因素包括长期大量吸烟(吸烟指数≥400支/d/年)、术前低FVC%(FVC%<70%)、鳞癌、发生淋巴结转移、TNM分期较晚(Ⅲ、Ⅳ期)、全肺切除及支气管切缘存留癌组织。多因素分析中,BPF的临床危险因素包括术前低FVC%、全肺切除、长期大量吸烟、支气管切缘存留癌组织,其OR值分别为8.97,7.76,6.60和4.45。结论对于吸烟指数≥400及术前FVC%<70%的患者应尽量避免全肺切除,如果必须采用此手术方式时则应该进行术中支气管残端冰冻切片检查,证实没有癌组织残留,以避免术后发生BPF。
Objective To retrospectively analyze the clinical risk factors of postoperative bronchopleural fistula (BPF) in patients with lung cancer. Methods A total of 639 cases of lung cancer undergoing surgery were analyzed and their risk factors were analyzed by single factor and Logistic regression models. Results The BPF occurred in 21 patients (20 males and 1 females), with a rate of 3.3% (21/639). Six of these patients died, with a case fatality rate of 28.6%. Clinical risk factors for BPF in univariate analysis included long-term mass smoking (smoking index ≥400 / d / year), preoperative low FVC% (FVC% <70%), squamous cell carcinoma, lymph node metastasis, and late TNM stage Ⅲ, Ⅳ), pneumonectomy and bronchial margin of cancer tissue. In multivariate analysis, the clinical risk factors of BPF included preoperative low FVC%, total pneumonectomy, long-term smoking, and bronchial cancer with OR of 8.97, 7.76, 6.60 and 4.45, respectively. Conclusions For patients with smoking index ≥400 and preoperative FVC% <70%, pneumonectomy should be avoided as far as possible. If the operation must be performed, intraoperative bronchial stump frozen section examination should be performed to confirm that there is no cancerous tissue to avoid Postoperative BPF.