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目的比较胃癌术后发生肺部并发症病人与无并发症病人间临床病理特征,并分析胃癌术后肺部并发症发生的危险因素。方法回顾性分析2012年1月至2015年12月四川大学华西医院胃肠外科收治的719例胃癌手术病人临床资料。排除残胃癌、术前接受化疗以及无肺部并发症但合并其他并发症病例后,分为肺部并发症组(103例)与无并发症组(616例)。结果肺部并发症组病人术后住院时间较无并发症组延长[(13.5±7.0)d vs.(10.7±3.1)d,P<0.001],其余指标组间差异无统计学意义(P>0.05)。单因素分析显示,年龄(P=0.018)、肺部疾病史(P<0.001)、术前肺功能[1 s用力呼气量与用力肺活量比值(FEV1/FVC),P=0.002]、血红蛋白(P=0.004)、术中出血(P=0.042)以及手术时间(P=0.048)与肺部并发症发生相关;多因素分析发现,肺部疾病史(P<0.001)、术前肺功能(P=0.032)以及血红蛋白(P=0.004)为影响胃癌术后肺部并发症发生的独立危险因素。结论对于BMI≥25、合并肺部基础疾病、FEV1/FVC<60、血红蛋白<90 g/L的胃癌病人,应注意采取必要措施以减少术后肺部并发症发生。
Objective To compare the clinicopathological characteristics of patients with postoperative complications of lung cancer and those without complications and to analyze the risk factors of postoperative complications of lung cancer. Methods The clinical data of 719 gastric cancer patients admitted to Department of Gastrointestinal Surgery, West China Hospital of Sichuan University from January 2012 to December 2015 were retrospectively analyzed. Excluding gastric cancer, chemotherapy before surgery and non-pulmonary complications but with other complications, the patients were divided into pulmonary complications group (n = 103) and no complications group (n = 616). Results The length of postoperative hospital stay in patients with pulmonary complications was longer than that in patients without complications [(13.5 ± 7.0) d vs. (10.7 ± 3.1) d, P <0.001]. There was no significant difference between the other groups (P> 0.05). Univariate analysis showed that age (P = 0.018), history of pulmonary disease (P <0.001), preoperative lung function [FEV1 / FVC for 1 s, P = 0.002], hemoglobin (P = 0.004), intraoperative bleeding (P = 0.042) and operation time (P = 0.048) were correlated with the incidence of pulmonary complications. Multivariate analysis showed that the incidence of pulmonary disease (P <0.001) = 0.032) and hemoglobin (P = 0.004) were independent risk factors for postoperative pulmonary complications. Conclusion Patients with gastric cancer with BMI≥25, pulmonary underlying diseases, FEV1 / FVC <60 and hemoglobin <90 g / L should take necessary measures to reduce postoperative pulmonary complications.