预测FEV和DLCO预测一般并发症,但没有长时间的空气泄漏在肺部细分切除术
Daniel Baum1, Monika Sombati2, Lysann Rostock2,3,4,5,6
1Department of Thoracic Surgery, Lung Center Coswig, Neucoswiger Str. 21, Coswig D-01640, Germany.
Therapeutic advances in respiratory disease
|July 8, 2025
概括
手术前的肺功能测试,包括1秒的强制呼吸量 (FEV1) 和一氧化碳的扩散能力 (DLCO),可以预测肺部切除术后的并发症. 然而,这些测试不能可靠地预测长时间的空气泄漏.
科学领域:
- 胸部外科手术 胸部外科手术
- 肺部医学 肺部医学
- 手术瘤学手术瘤学
背景情况:
- 肺部细分切除术是针对早期非小细胞肺癌 (NSCLC) 的叶片切除术的一个可行的替代方案.
- 预测术后并发症和长时间的空气泄漏 (PAL) 对于分段切除术患者的选择至关重要.
- 现有的评分系统很复杂,FEV1和DLCO等个别因素的预测价值尚未得到充分研究.
研究的目的:
- 评估手术前强制呼吸量在1秒 (FEV1) 和一氧化碳 (DLCO) 扩散能力的预测能力,用于复发症 (Clavien-Dindo ≥3a) 和在接受肺部切除术的患者中PAL.
- 评估FEV1和DLCO在识别细分切除术后具有较高不良结果风险的患者的准确性.
主要方法:
- 回顾性,单中心研究,比较NSCLC的细分切除术 (n=33) 和分片切除术 (n=126).
- 分析患者特征,并发症率和PAL发生率.
- 后勤回归和ROC曲线分析以确定FEV1和DLCO对并发症和PAL的预测准确度.
主要成果:
- 在分片切除和分片切除组之间,FEV1和DLCO是可比的.
- FEV1显著预测并发症,较低的值表明风险增加.
- 在细分切除术中的并发症中,DLCO表现出强大的预测价值 (AUC=0.924).
- 无论FEV1还是DLCO都没有预测PAL,这发生在30%的细分切除术患者和20%的叶片切除术患者中.
结论:
- 手术前的FEV1和DLCO是肺部切除术后并发症的有价值预测指标,DLCO显示高准确度.
- 由于FEV1和DLCO无法预测PAL,因此需要多因素风险评估模型.
- 这些发现支持FEV1和DLCO在分段切除术患者手术前风险分层的临床实用性,尽管样本大小有限.
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