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中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2020, Vol. 07 ›› Issue (04) : 224 -232. doi: 10.3877/cma.j.issn.2095-8773.2020.04.05

所属专题： 文献；

综述

食管癌术后肺部并发症的预测与对策
徐建峰1, 周军庆1, 魏德胜1, 王彬1, 傅林海1, 李铸鹏1, 喻光懋1,†()   
  1. 1. 312000　绍兴，绍兴市人民医院心胸外科
  • 收稿日期:2020-09-29 修回日期:2020-11-24 接受日期:2020-11-25 出版日期:2020-11-28
  • 通信作者: 喻光懋
  • 基金资助:
    绍兴市青年科研基金项目(2020YB27)

Prediction and prevention of postoperative pulmonary complications after esophageal cancer surgery

Jianfeng Xu1, Junqing Zhou1, Desheng Wei1, Bing Wang1, Linhai Fu1, Zhupeng Li1, Guangmao Yu1,†()   

  1. 1. Department of Cardiothoracic Surgery, Shaoxing People’s Hospital, Shaoxing 312000, China
  • Received:2020-09-29 Revised:2020-11-24 Accepted:2020-11-25 Published:2020-11-28
  • Corresponding author: Guangmao Yu
  • About author:
    Corresponding author: Yu Guangmao, Email:
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引用本文：

徐建峰, 周军庆, 魏德胜, 王彬, 傅林海, 李铸鹏, 喻光懋. 食管癌术后肺部并发症的预测与对策[J]. 中华胸部外科电子杂志, 2020, 07(04): 224-232.

Jianfeng Xu, Junqing Zhou, Desheng Wei, Bing Wang, Linhai Fu, Zhupeng Li, Guangmao Yu. Prediction and prevention of postoperative pulmonary complications after esophageal cancer surgery[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2020, 07(04): 224-232.

食管切除术是治疗食管癌的基石，作为食管切除术后最常见的并发症，肺部并发症被认为是预测患者预后最重要的因素，预防肺部并发症的发生在食管癌术后有着重要意义。术后肺部并发症一直是食管切除术的研究热点，近期国内专家共识的发表规范了术后肺炎的诊疗措施，但关于肺炎的定义目前仍未得到统一，同时外科新技术的普及仍面临挑战。本文通过检索PubMed、Wiley、Sciencedirect、知网和万方数据库，回顾以往食管切除术后肺部并发症的相关研究报道、综述和指南，进行归纳和总结，从术前状态、手术因素和术后管理3方面阐述食管切除术后肺部并发症的影响因素，并基于此提出一些相应的策略。

关键词: 食管癌, 手术, 肺部并发症

Esophagectomy is the cornerstone of the treatment of esophageal cancer. As the most common complication after esophagectomy, pulmonary complications are considered to be the most important prognostic factor. Prevention of pulmonary complications is of great significance after esophageal cancer surgery. Postoperative pulmonary complications have always been a hot research topic in esophagectomy. Recently, the publication of consensus among domestic experts has standardized the diagnosis and treatment measures of postoperative pneumonia in esophageal cancer patients. However, the definition of pneumonia has not been unified, and the popularization of new surgical techniques is still facing challenges. By searching PubMed, Wiley, Sciencedirect, CNKI and Wanfang database, the related research reports, reviews and guidelines on pulmonary complications after esophagectomy were reviewed and summarized. In this paper, the influencing factors of postoperative pulmonary complications after esophagectomy were discussed from three aspects: preoperative state, surgical factors and postoperative management, based on which some corresponding strategies were proposed.

Key words: Esophageal cancer, Surgery, Pulmonary complications
表1 文献检索
数据库 检索年限 检索术语 文献数量 网址
PubMed 2004—2020 （Pulmonary complications[Title] OR Respiratory complications[Title]）AND（esophagectomy[Title] OR esophageal cancer[Title]） 65 https://pubmed.ncbi.nlm.nih.gov
Wiley 2000—2020 （Pulmonary complications[Title]+esophagectomy[Title]）/（Pulmonary complications[Title]+esophageal cancer [Title]） 10 https://onlinelibrary.wiley.com
Sciencedirect 2000—2020 （Pulmonary complications[Title]+esophagectomy[Title]）/（Pulmonary complications[Title]+esophageal cancer[Title]） 31 www.sciencedirect.com
表2 术后PC风险因素的相关研究
第一作者 发表年份 患者人数 数据时间 数据来源 观察目标 发生率（%） 独立风险因素
Simon等[9] 2004 421 1990年1月—2001年12月 中国香港 支气管肺炎、吸入性肺炎和呼吸衰竭 15.9 年龄、手术时间、肿瘤位置
Nakamura等[21] 2008 184 1991—2005 日本 支气管肺炎、吸入性肺炎和呼吸衰竭 19.6 呼吸理疗、皮质类固醇的使用、术中出血
Dhunge等[12] 2010 1032 2005—2008 美国 肺炎、非计划插管、呼吸机依赖>48 h 27 糖尿病、吸烟、喝酒、手术时间
Ferguson等[10] 2011 516 1980—2009 美国 孤立性呼吸功能不全和肺炎 38 年龄、FEV1%、Dlco%、血清肌酐、目前吸烟、开胸手术、表现状态
Paul等[23] 2011 112 2003年1月—2006年12月 澳大利亚 急性呼吸窘迫综合征 13.4 呼吸系统共病，吸烟，FEV1%，FiO2，围手术期肌力药物的使用
Zingg等[31] 2011 858 1998—2008 澳大利亚 肺炎，需要干预的胸腔积液，呼吸衰竭和急性呼吸窘迫综合征 27.4 吸烟，合并症数量
Bakhos等[11] 2012 220 2002年1月—2009年1月 美国 肺炎，需要干预的胸腔积液，呼吸衰竭，肺栓塞，需要进行支气管镜检查或气管造口术 23.6 年龄，缺乏幽门引流术
Shiozaki等[24] 2012 96 2007—2009 日本 肺炎，急性呼吸窘迫综合征 20.8 FEV1%，CRP，吸烟史
Naoya等[22] 2014 299 2005年4月—2012年7月 日本 初始通气支持时间>48 h、呼吸衰竭、肺炎、急性呼吸窘迫、任何需要干预或外科治疗的肺部疾病 17.7 吸烟、术前放化疗、术中出血
Tomoyuki等[14] 2018 184 2011年5月—2016年12月 日本 初始通气支持时间>48 h、呼吸衰竭、肺炎、任何需要干预或外科治疗的肺部疾病 17.9 布林克曼指数、肿瘤分期
张义兵等[6] 2018 213 2014年12月—2016年12月 中国 肺炎、胸腔积液和呼吸衰竭，其他有脓胸、气胸/肺复张不良、肺水肿、支气管痉挛等 17.37 年龄、美国麻醉师协会分级（ASA分级）、糖尿病史、肺结核病史、术后其他并发症、单肺通气、长期大量吸烟、FEV1%
Ohi等[7] 2019 89 2010年1月—2015年12月 日本 支气管循环障碍，通气障碍，肺不张，肺炎，纵隔炎，脓胸，呼吸衰竭和急性呼吸窘迫、Clavien-Dindo分级2级或以上 21.3 COPD、术后谵妄
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