Prediction and prevention of postoperative pulmonary complications after esophageal cancer surgery

doi:10.3877/cma.j.issn.2095-8773.2020.04.05

Abstract

Abstract:

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

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.

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References 72

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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

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

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

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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