«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2024年06期

页码:

907-912

栏目:

论著

出版日期:

2024-12-25

文章信息/Info

Title:

Clinical analysis of lobar emphysema ratio for predicting persistent air leakage after video-assisted thoracoscopic lobectomy in NSCLC

作者:

谢鹏飞¹; 陈 佳²; 张晓东²; 张春荣¹; 许 峰¹

226361 南通,南通市肿瘤医院/南通大学附属肿瘤医院胸外科¹
226361 南通,南通市肿瘤医院/南通大学附属肿瘤医院肿瘤内科²

Author(s):

Xie Pengfei¹;  Chen Jia²;  Zhang Xiaodong²;  Zhang Chunrong¹;  Xu Feng¹.

¹Department of Thoracic Surgery, Nantong Cancer Hospital/Affiliated Cancer Hospital of Nantong University, Nantong 226361, China; ²Department of Oncology, Nantong Cancer Hospital/Affiliated Cancer Hospital of Nantong University, Nantong 226361, China

关键词:

非小细胞肺癌;  肺叶气肿比值;  电视胸腔镜肺叶切除术;  持续性漏气

Keywords:

Pulmonary emphysema ratio;  Non-small cell lung cancer;  Video-assisted thoracoscopic lobectomy;  Persistent leak

分类号:

R734.2

DOI:

10.3877/cma.j.issn.1674-6902.2024.06.010

摘要:

目的 分析肺叶气肿比值(lobar emphysema ratio, LER)预测Ⅰ～ⅢA期非小细胞肺癌(non-small cell lung cancer, NSCLC)电视胸腔镜(video-assisted thoracoscopic/thoracic surgery, VATS)肺切除术后持续性漏气(persistent air leak, PAL)的临床意义。方法 选择2021年1月至2024年1月我院收治的经VATS肺叶切除术治疗NSCLC患者117例为对象。记录术后PAL(肺切除术后肺漏气时间>5 d),PAL 19例为观察组,无PAL 98例为对照组。采用Spearman秩相关性分析相关性。多因素Logistic回归分析影响NSCLC患者VATS后PAL危险因素。采用受试者工作特性曲线预测NSCLC患者VATS后发生PAL风险。结果 术后第1天漏气67例, 5 d内停止漏气48例,19例(16.23%)漏气>5 d。住院期无死亡,出院未行胸管引流。平均住院时长(6.62±4.01)d,漏气持续时间(2.93±3.42)d。观察组肺气肿比值(emphysema ratio, ER)0.11(0.02,1.01)%高于对照组 2.13(0.85,3.07)%,观察组LER右肺上叶0.10(0.01,1.38)%、右肺中叶0.18(0.02,1.00)%、右肺下叶0.04(0.00,0.46)%、左肺上叶0.09(0.01,1.32)%、左肺下叶0.06(0.00,0.53)%高于对照组右肺上叶2.59(0.39,6.16)%、右肺中叶0.72(0.36,2.00)%、右肺下叶1.29(0.13,2.36)%、左肺上叶1.52(0.74,2.75)%、左肺下叶1.75(0.35,3.05)%。Spearman秩相关性分析显示,ER与LER呈强正相关(rho=0.857,P=0.000)。LER预测NSCLC患者VATS后发生PAL的AUC为0.876(95%CI:0.817～0.922),最佳截断值(0.75)灵敏度、特异度分别为85.71%、80.28%,阳性及阴性预测值分别为82.27%、84.03%; ER预测NSCLC患者VATS后发生PAL的AUC为0.792(95%CI:0.723～0.850),最佳截断值(0.18)灵敏度、特异度分别为92.86%、57.75%,阳性及阳性预测值分别为70.12%、88.34%。LER预测PAL发生价值高于ER(Z=2.875,P=0.004)。Logistic回归分析显示,吸烟史(OR=5.888,P=0.037)、T2-T3肿瘤分期(OR=2.696,P=0.036)、呼吸合并症(OR=2.928,P=0.030)及LER>0.75(OR=15.693,P=0.000)可预测PAL。结论 ER和LER可预测Ⅰ～ⅢA期NSCLC患者VATS肺切除术后PAL发生,LER的预测有意义。

Abstract:

Objective To analyze the lobar emphysema ratio(LER)for predicting stage Ⅰ-ⅢA non-small cell lung cancer(non-small cell lung cancer). The clinical significance of video-assisted thoracoscopic/thoracic surgery(VATS)after pulmonary resection for persistent air leak(PAL). Methods All of 117 patients with NSCLC treated by VATS pulmonary lobectomy from January 2021 to January 2024 were selected as subjects. PAL(lung leakage time >5 days after pneumonectomy)was recorded, 19 cases of PAL were observed and 98 cases without PAL were control group. Spearman rank correlation was used to analyze the correlation. Multivariate Logistic regression analysis of PAL risk factors after VATS in NSCLC patients. Subject operating characteristic curves were used to predict PAL risk after VATS in NSCLC patients. Results 67 cases had gas leakage on the first day after operation, 48 cases stopped gas leakage within 5 days, 19 cases(16.23%)had gas leakage >5 days. There was no death during hospitalization, and no chest tube drainage was performed after discharge. The average length of hospitalization was(6.62±4.01)d and the duration of air leakage was(2.93±3.42)d. The emphysema ratio(ER)of 0.11(0.02, 1.01)% in the observation group was higher than that of the control group by 2.13(0.85, 3.07)%. The upper lobe of the right lung in the observation group was 0.10(0.01, 1.38)and the middle lobe of the right lung was 0.18(0.02, 1.00)%, lower lobe of right lung 0.04(0.00, 0.46)%, upper lobe of left lung 0.09(0.01, 1.32)%, lower lobe of left lung 0.06(0.00, 0.53)% were higher than those of control group 2.59(0.39, 6.16)%, middle lobe of right lung 0.72(0.36, 2.00)%, right inferior lobe 1.29(0.13, 2.36)%, left superior lobe 1.52(0.74, 2.75)%, left inferior lobe 1.75(0.35, 3.05)%. Spearman rank correlation analysis showed a strong positive correlation between ER and LER(rho=0.857, P=0.000). LER predicted that the AUC of PAL after VATS in NSCLC patients was 0.876(95%CI: 0.817-0.922), the optimal cut-off value(0.75), sensitivity and specificity were 85.71% and 80.28%, and positive and negative predictive values were 82.27% and 84.03%, respectively. The AUC of ER predicting PAL after VATS in NSCLC patients was 0.792(95%CI: 0.723-0.850), the optimal cut-off value(0.18)was 92.86%, the specificity was 57.75%, and the PPV and NPV were 70.12% and 88.34%, respectively. LER predicted that PAL occurrence was higher than ER(Z=2.875, P=0.004). Logistic regression analysis showed that smoking history(OR=5.888, P=0.037), T2-T3 tumor stage(OR=2.696, P=0.036), respiratory complications(OR=2.928, P=0.030)and LER >0.75(OR=15.693, P=0.000)predicted PAL. Conclusion ER and LER can predict PAL in patients with stage Ⅰ-ⅢA NSCLC after pulmonary resection of VATS, and the prediction of LER is significant.

参考文献/References:

1 滕艳华, 马 宁. 胸腔镜下肺部肿瘤切除术后合并持续性肺漏气患者心理体验的质性研究[J]. 护士进修杂志, 2021, 36(21): 2012-2015.
2 Zheng Q, Ge L, Zhou J, et al. Risk factors for prolonged air leak after pulmonary surgery: A systematic review and meta-analysis[J]. Asian J Surg, 2022, 45(11): 2159-2167.
3 Clark JM, Cooke DT, Brown LM. Management of complications after lung resection: prolonged air leak and bronchopleural fistula[J]. Thorac Surg Clin, 2020, 30(3): 347-358.
4 方德根, 任彦红, 李春雷. 3D-VATS联合3D-CTBA单操作孔行解剖性肺段切除治疗早期NSCLC的临床分析[J/CD]. 中华肺部疾病杂志(电子版), 2023, 16(1): 89-91.
5 Zeng W, Zhang W, Zhang J, et al. Systematic review and meta-analysis of video-assisted thoracoscopic surgery segmentectomy versus lobectomy for stage I non-small cell lung cancer[J]. World J Surg Oncol, 2020, 18(1): 44.
6 Rathore K, Newman M. Prolonged air leak following video-assisted thoracoscopic major lung resection: newer avenues to manage an age-old problem[J]. Indian J Thorac Cardiovasc Surg, 2022, 38(4): 394-397.
7 Li R, Xue M, Ma Z, et al. Construction and validation of a nomogram for predicting prolonged air leak after minimally invasive pulmonary resection[J]. World J Surg Oncol, 2022, 20(1): 249.
8 Moon DH, Park CH, Kang DY, et al. Significance of the lobe-specific emphysema index to predict prolonged air leak after anatomical segmentectomy[J]. PLoS One, 2019, 14(11): e0224519.
9 Heo JW, Kang HS, Park CK, et al. Regional emphysema score is associated with tumor location and poor prognosis in completely resected NSCLC patients[J]. BMC Pulm Med, 2020, 20(1): 242.
10 Miller MR, Crapo R, Hankinson J, et al. General considerations for lung function testing[J]. Eur Respir J, 2005, 26(1): 153-61.
11 Nath TS, Mohamed N, Gill PK, et al. A comparative analysis of video-assisted thoracoscopic surgery and thoracotomy in non-small-cell lung cancer in terms of their oncological efficacy in resection: A systematic review[J]. Cureus, 2022, 14(5): e25443.
12 Gonzalez M, Brunelli A, Szanto Z, et al. Report from the European Society of Thoracic Surgeons database 2019: current surgical practice and perioperative outcomes of pulmonary metastasectomy[J]. Eur J Cardiothorac Surg, 2021, 59(5): 996-1003.
13 Grott M, Eichhorn M, Eichhorn F, et al. Thoracic surgery in the non-intubated spontaneously breathing patient[J]. Respir Res, 2022, 23(1): 379.
14 Acar K, Ersöz H. Comparison of three different surgical techniques in patients undergoing VATS and open thoracotomy[J]. J Perianesth Nurs, 2022, 37(4): 479-484.
15 Fan CY, Lin CW, Sung CW, et al. Therapeutic potential of physical stabilization in VATS pain control: a randomized controlled trial[J]. Updates Surg, 2024: 1-7.
16 Clark JM, Cooke DT, Brown LM. Management of complications after lung resection: prolonged air leak and bronchopleural fistula[J]. Thorac Surg Clin, 2020, 30(3): 347-358.
17 Koga H, Nakamura H, Murakami H, et al. Thoracoscopic pulmonary lobectomy for densely fused pulmonary lobes in children with congenital pulmonary airway malformation: technical tips[J]. J Laparoendosc Adv Surg Tech A, 2019, 29(3): 415-419.
18 Zaraca F, Vaccarili M, Zaccagna G, et al. Can a standardised ventilation mechanical test for quantitative intraoperative air leak grading reduce the length of hospital stay after video-assisted thoracoscopic surgery lobectomy?[J]. J Vis Surg, 2017, 3: 179.
19 Chopra A, Hu K, Judson MA, et al. Association between drainage-dependent prolonged air leak after partial lung resection and clinical outcomes: a prospective cohort study[J]. Ann Am Thorac Soc, 2022, 19(3): 389-398.
20 Leivaditis V, Skevis K, Mulita F, et al. Advancements in the management of postoperative air leak following thoracic surgery: from traditional practices to innovative therapies[J]. Medicina, 2024, 60(5): 802.
21 Ikeda T, Sasaki M, Yamada N, et al. Controlling air leaks using free pericardial fat pads as surgical sealant in pulmonary resection[J]. Ann Thorac Surg, 2015, 99(4): 1170-1175.
22 Cerfolio RJ. Chest tube management after pulmonary resection[J]. Chest Surg Clin N Am, 2002, 12(3): 507-527.
23 Hou X, Chen H, Liu Y, et al. Clinicopathological and computed tomography features of patients with early-stage non-small-cell lung cancer harboring ALK rearrangement[J]. Cancer Imaging, 2023, 23(1): 20.
24 张庆团, 郭兴全, 王家赐. 低剂量CT联合血清肿瘤标志物在早期非小细胞肺癌诊断中的应用价值[J]. 中国CT和MRI杂志, 2023, 21(2): 58-60.
25 Zhang Y, Yi J, Sun D, et al. The association of chest computed tomography-defined visual emphysema and prognosis in patients with nonsmall cell lung cancer[J]. ERJ Open Res, 2023, 9(6): 00195-2023.
26 Noda Y, Shiroyama T, Masuhiro K, et al. Quantitative evaluation of emphysema for predicting immunotherapy response in patients with advanced non-small-cell lung cancer[J]. Sci Rep, 2022, 12(1): 8881.
27 Yasuura Y, Terada Y, Mizuno K, et al. Quantitative severity of emphysema is related to the prognostic outcome of early-stage lung cancer[J]. Eur J Cardiothorac Surg, 2022, 62(5): ezac499.
28 Liu Y, Feng ZW, Liu XM, et al. Association of lung cancer risk with the presence of both lung nodules and emphysema in a lung cancer screening trial[J]. World J Oncol, 2024, 15(2): 246-256.
29 Lee JP, Na JB, Choi HC, et al. Lobar emphysema ratio of more than 1% in the lobe with lung cancer as poor predictor for recurrence and overall survival in patients with stage I non-small cell lung cancer[J]. PLoS One, 2023, 18(2): e0281715.
30 Kim JS, Lee S, Suh SW, et al. Association of low blood pressure with white matter hyperintensities in elderly individuals with controlled hypertension[J]. J Stroke, 2020, 22(1): 99-107.

备注/Memo

备注/Memo:

基金项目: 江苏省2022年项目(M202207)
通信作者: 许 峰, Email: xufeng19861015@126.com

常用功能

更新日期/Last Update: 2024-12-25