Multivariate Analysis of Cough After Pulmonary Resection by Video-assisted Thoracoscopic Surgery

目的 探讨胸腔镜肺切除术后持续咳嗽(cough after pulmonary resection,CAP)发生的预后因素. 方法 回顾性分析2014年4月~2016年3月我科650例肺癌胸腔镜肺切除术的临床资料,根据术后是否发生持续咳嗽分为CAP组和非CAP组,单因素分析包括性别、年龄、吸烟史、病理类型、纵隔淋巴结转移、手术侧(左侧或右侧)、手术肺叶(上叶或非上叶)、手术方式、淋巴结切除方式、气管树周围淋巴结切除、离断下肺韧带、出院时合并气胸、出院时合并胸水,采用logistic回归进行多因素分析. 结果 术后发生CAP 175例,占26.9%.单因素分析显示,年龄、吸烟史、手术侧、切除肺叶、气管树周围淋巴结切除、出院时合并气胸有统计学差异(P<0.05).多因素回归分析显示,年龄(OR=0.616,95% CI:0.424~0.895, P=0.011)、吸烟史(OR=0.656,95% CI:0.432~0.997, P=0.048)、手术侧(OR=1.814,95% CI:1.241~2.652, P=0.002)、切除肺叶(OR=1.789,95% CI:1.214~2.636, P=0.003)、气管树周围淋巴结切除(OR=2.730,95% CI:1.126~6.622, P=0.026)是CAP发生的预后因素. 结论 持续咳嗽是胸腔镜肺切除术后的常见并发症之一.年龄<63岁、无吸烟史、右侧手术、上叶手术、有气管树周围淋巴结切除的患者更易发生CAP.Objective To analyze prognostic factors of cough after pulmonary resection (CAP) by video-assisted thoracoscopic surgery(VATS).Methods A retrospective analysis of 650 patients who underwent thoracoscopic pulmonary resection for lung cancer in our hospital between April 2014 and March 2016 was carried out.All those patients were divided into either CAP group or non-CAP group.The univariate analysis included gender, age, smoking history, pathological type, mediastinal lymph nodes metastasis, operation side, operation lobe, operative approaches, extention of mediastinal lymphadenectomy, para-bronchial tree lymph nodes resection, inferior pulmonoary ligaments division, pneumothorax when discharged, and pleural effusion when discharged.The multivariate analysis was also conducted by logistic regression.Results A total of 175 cases (26.9%) were included in the CAP group.The univariate analysis showed that age, smoking history, operation side, operation lobe, para-bronchial tree lymph nodes resection, pneumothorax when discharged had significantly statistical difference between the two groups (P<0.05).The multivariate analysis showed that younger than 63 years old (OR=0.616, 95% CI: 0.424-0.895, P=0.011), smoking history (OR=0.656, 95% CI: 0.432-0.997, P=0.048), operation side (OR=1.814, 95% CI: 1.241-2.652, P=0.002), operation lobe (OR=1.789, 95% CI: 1.214-2.636, P=0.003), and para-bronchial tree lymph nodes resection (OR=2.730, 95% CI: 1.126-6.622, P=0.026) were independent prognostic factors of CAP.Conclusions CAP is a common postoperative complication of pulmonary resection by VATS.There is a significant relationship between CAP and age, smoking history, operation side, operation lobe and para-bronchial tree lymph nodes resection.首都卫生发展科研专项项目中国科学引文数据库(CSCD)7577-5801