微创医学

目的分析肺结节患者行胸腔镜术后发生肺部并发症的危险因素。方法回顾性分析104例肺结节患者的性别、年龄、吸烟史、身体质量指数、合并高血压情况、淋巴结清扫数目、受教育程度等临床资料，所有患者均行胸腔镜下肺结节切除术。根据术后是否发生肺部并发症将患者分为并发症组和无并发症组，分析肺结节患者胸腔镜术后发生肺部并发症的危险因素。结果 104例肺结节患者均顺利完成胸腔镜手术，其中21例患者发生肺部并发症（肺部感染5例、气胸2例、呼吸衰竭1例、胸腔积液3例、支气管痉挛3例、下肢静脉血栓3例、肺不张4例），并发症发生率为20.19%。根据患者有无肺部并发症将其分为并发症组（n=21）和无并发症组（n=83）。两组患者的年龄、吸烟史、合并糖尿病情况、合并低蛋白血症情况、术中出血量、首次下床活动时间、术前呼气峰流速（PEF）、手术时间、术后住院时间比较，差异均有统计学意义（均P<0.05）。多因素Logistic回归分析结果显示，年龄≥60岁、合并糖尿病、术中出血量≥200 mL、首次下床活动时间≥3 d、术前PEF<300 L/min及手术时间≥120 min均是导致肺结节患者胸腔镜术后肺部并发症发生的独立危险因素（均P<0.05）。结论肺结节患者胸腔镜手术后肺部并发症发生风险较高，年龄≥60岁、合并糖尿病、术中出血量≥200 mL、首次下床活动时间≥3 d、术前PEF<300 L/min及手术时间≥120 min是导致术后肺部并发症发生的独立危险因素，临床应提高警惕。

Objective To analyze the risk factors of pulmonary complications after thoracoscopic surgery in patients with pulmonary nodules. Methods The clinical data of 104 patients with pulmonary nodules, including gender, age, smoking history, body mass index, hypertension, number of lymph node dissection and education degree were retrospectively analyzed. All patients underwent thoracoscopic pulmonary nodule resection. According to the presence or absence of postoperative pulmonary complications, patients were divided into complication group and non-complication group, and the risk factors of postoperative pulmonary complications in patients with pulmonary nodules were analyzed. Results All 104 patients with pulmonary nodules successfully completed thoracoscopic surgery, among which 21 patients had pulmonary complications (5 cases of pulmonary infection, 2 cases of pneumothorax, 1 case of respiratory failure, 3 cases of pleural effusion, 3 cases of bronchospasm, 3 cases of venous thrombosis of lower limbs and 4 cases of atelectasis), with an incidence of complications of 20.19%. According to the presence or absence of pulmonary complications, the patients were divided into complication group (n=21) and non-complication group (n=83). There were statistically significant differences in age, smoking history, complicated with diabetes, complicated with hypoproteinemia, intraoperative blood loss, first ambulation time, preoperative peak expiratory flow (PEF), operation time, and postoperative hospital stay between the two groups (all P<0.05). Multivariate Logistic regression analysis showed that age≥60 years, complicated with diabetes, intraoperative blood loss≥200 mL, first ambulation time≥3 days, preoperative PEF<300 L/min and operation time≥120 min were independent risk factors for postoperative pulmonary complications in patients with pulmonary nodules after thoracoscopic surgery (all P<0.05). Conclusion Patients with pulmonary nodules have a high risk of postoperative pulmonary complications after thoracoscopic surgery. Age≥60 years old, complicated with diabetes, intraoperative blood loss ≥200 mL, first ambulation time≥3 days, preoperative PEF<300 L/min and operation time ≥120 min are independent risk factors for postoperative pulmonary complications, which should be paid more attention in clinical practice.