Ann Thorac Surg：全肺切除术后导致肺部良性病变患者早期并发症的危险因素

全肺切除术是中央型肺癌的常用手术方式。特定情况下，某些具有相应指征的良性病变患者也必须行全肺切除术，如肺结核并发症，化脓性肺病，纤维性纵膈炎等。然而，全肺切除术后并发症发病率很高。来自上海肺科医院的一项研究近期发表在《胸外科年鉴》上，该研究主要阐明了引起术后并发症的危险因素。

本研究对136名全肺切除患者进行了回顾性分析，这些病人肺部病变均为良性。术后30天对患者进行了随访。单变量和多元统计方法分析了这些患者中全肺切除术后的危险因素。结果显示：33名患者出现术后并发症，占24.26%。其中支气管胸膜瘘发生比率为6.1%，即136人中9人发病。5名患者于术手术期间死亡，占3.68%。单变量和多元统计分析结果显示：疾病类型（危害比，3.158；95%可信区间1.248至7.992；P=0.015）和手术时间（危害比，2.508；95%可信区间1.035至6.08；P=0.042）是术后并发症的独立危险因素，而疾病类型（危害比，6.409；95%可信区间1.669至6.021；P=0.011）和肺功能（危害比，6.159；95%可信区间0.018至0.625；P=0.013）是全肺切除术后患者发生支气管胸膜瘘的独立危险因素。

最后研究得出如下结论：肺部良性病变的患者在全肺切除术后并发症发病率很高。多元统计结果显示发病类型、手术时间、感染性肺病和肺功能低下是术后发病率主要的独立危险因素。然而，目前全肺切除术仍然是肺部良性病变患者较为满意的治疗方法。

Risk Factors for Early Postoperative Complications After Pneumonectomy for Benign Lung Disease.
BACKGROUND
Pneumonectomy is associated with a significant incidence of postoperative complications. The purpose of this study is to identify the risk factors associated with adverse outcomes.
METHODS
One hundred thirty-six patients with benign lung disease who underwent pneumonectomy were included in this retrospective analysis. Postoperative complications were observed during the 30-day follow-up. Univariate and multivariate analysis was performed to investigate the risk factors of pneumonectomy among the patients.
RESULTS
Postoperative complications were observed in 33 patients (24.26%). The rate of bronchopleural fistula was 6.1% (9 of 136). Five perioperative deaths (3.68%) were noted. Univariate analysis and multivariate analysis indicated that type of disease (hazard ratio [HR], 3.158; 95% confidence interval [CI], 1.248 to 7.992; p = 0.015) and operation duration (HR, 2.508; 95% CI, 1.035 to 6.080; p = 0.042) were independent risk factors of postoperative complications, and that type of disease (HR, 6.409; 95% CI, 1.669 to 6.021; p = 0.011) and pulmonary function (HR, 6.159; 95% CI, 0.018 to 0.625; p = 0.013) were independent risk factors of bronchopleural fistula for patients with benign lung disease after pneumonectomy.
CONCLUSIONS
A high incidence of complications was reported among patients with benign lung disease after pneumonectomy. The type of disease and operation duration were the best independent predictors of morbidity after this surgery. With careful patient selection and operative technique, morbidity and mortality rates could be comparable to those for pneumonectomy in cancer patients. Pneumonectomy is still a satisfactory treatment method for benign lung disease.