摘要
背景胸腔镜肺叶切除术可明显改善肺癌手术患者的预后,但是合并症负担是否增加胸腔镜肺叶切除术后并发症的发生率仍存在争议。目的评估合并症负担对早期非小细胞肺癌(NSCLC)患者胸腔镜肺叶切除术后并发症的影响。方法选取2010-2017年在常州市武进人民医院接受胸腔镜肺叶切除术或肺段切除术的早期NSCLC患者512例。采用查尔森合并症指数(CCI)评估患者总体合并症负担,并将患者分为高合并症负担组(CCI评分≥3分)和低合并症负担组(CCI评分<3分)。通过倾向性评分匹配模型进行数据调整,广义线性混合模型分析高合并症负担对患者术后并发症发生率的影响。结果高合并症负担193例(37.7%),低合并症负担319例(62.3%)。高合并症负担组和低合并症负担组术后死亡、肺部并发症、心血管并发症、其他并发症的发生率及并发症总发生率比较,差异均无统计学意义(P>0.05)。经倾向性评分匹配分析调整后,高合并症负担组和低合并症负担组各包括193例患者。倾向性评分匹配后,高合并症负担组和低合并症负担组术后死亡、肺部并发症、心血管并发症、其他并发症的发生率及并发症总发生率比较,差异均无统计学意义(P>0.05)。广义线性混合模型分析结果表明行胸腔镜肺叶切除术后,高合并症负担对术后并发症发生率无显著影响(P>0.05)。结论胸腔镜肺叶切除术可降低多合并症早期NSCLC患者术后死亡率以及合理范围内的并发症发生率。高合并症负担与胸腔镜肺叶切除术后并发症发生率无关。
Background Thoracoscopic lobectomy can significantly improve the post-surgical prognosis in patients with lung cancer,but it remains controversial that comorbidity burden increases the incidence of complications after thoracoscopic lobectomy.Objective To examine the association of comorbidity burden with the incidence of complications in early-stage nonsmall cell lung cancer(NSCLC)after thoracoscopic lobectomy.Methods From 2010 to 2017,512 patients with early-stage NSCLC who underwent thoracoscopic lobectomy or segmentectomy in Changzhou Wujin People's Hospital were selected and divided into high and low comorbidity burden〔Charlson Comorbidity Index(CCI)score≥3 and<3,respectively〕groups.Propensity score was used to control the confounders.A generalized linear mixed model was used to analyze the association of high comorbidity burden with the incidence of postoperative complications.Results High comorbidity burden group〔37.7%(193/512)〕showed no significantly different incidence of post-surgical death,pulmonary,cardiovascular and other complications as well as overall incidence of postoperative complications compared with low comorbidity burden group〔62.3%(319/512)〕(P>0.05).After a propensity score-matched analysis,each group included 193 patients,showing no significant intergroup differences in the incidence of postoperative death,pulmonary,cardiovascular and other complications,as well as the overall incidence of complications(P>0.05).In the generalized linear mixed model,high comorbidity burden had no significant association with postoperative complications(P>0.05).Conclusion Thoracoscopic lobectomy may reduce postoperative mortality in earlystage NSCLC patients with multiple comorbidities.Moreover,it may also reduce the possibility of having complications to a certain extent.High comorbidity burden was not related to the incidence of complications after thoracoscopic lobectomy.
作者
吕亚军
黄艳红
张久荣
LYU Yajun;HUANG Yanhong;ZHANG Jiurong(Changzhou Wujin People's Hospital,Changzhou 213000,China)
出处
《中国全科医学》
CAS
北大核心
2020年第20期2498-2502,2519,共6页
Chinese General Practice
