• 同濟(jì)大學(xué)附屬上海市肺科醫(yī)院 胸外科,上?!?00433;

目的 探討肥胖對(duì)肺切除術(shù)后并發(fā)癥發(fā)生和手術(shù)死亡率的影響。 方法 回顧性分析2003年9月至2007年12月上海市肺科醫(yī)院3 494例肺部疾病行肺切除術(shù)患者的臨床資料,依據(jù)體重指數(shù)(body mass index,BMI)不同將3 494例患者分為兩組,非肥胖組(BMI<28 kg/m2):3 340例,男2 502例,女838例;年齡(61.9±10.7)歲;肥胖組(BMI≥28 kg/m2):154例,男87例,女67例;年齡(59.7±9.6)歲。通過(guò)單因素和logistic多因素回歸分析肥胖(BMI≥28 kg/m2)對(duì)肺切除術(shù)后并發(fā)癥發(fā)生的影響。 結(jié)果 圍術(shù)期共死亡26例,其中非肥胖組死亡23例,肥胖組死亡3例,兩組患者的病死率比較差異無(wú)統(tǒng)計(jì)學(xué)意義[0.7% (23/3 340) vs. 1.9% (3/154),P=0.118]。兩組患者任一并發(fā)癥和呼吸系統(tǒng)并發(fā)癥發(fā)生率比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。除呼吸系統(tǒng)外,肥胖組患者其它系統(tǒng)并發(fā)癥發(fā)生率顯著高于非肥胖組(P<0.05),腦血管意外、心肌梗死和急性腎功能衰竭發(fā)生率高于非肥胖組(P<0.05)。Logistic多因素回歸分析結(jié)果顯示:肥胖(BMI≥28 kg/m2)不是肺切除術(shù)后并發(fā)癥發(fā)生的獨(dú)立危險(xiǎn)因素[回歸系數(shù)為0.648、OR值為1.911,95% CI (0.711,5.138),P值為0.199]?!〗Y(jié)論 肥胖不引起肺切除術(shù)后手術(shù)死亡率和并發(fā)癥發(fā)生率的顯著增高。

引用本文: 宋楠,姜格寧,王海峰,劉明,何文新,張鵬,丁嘉安. 肥胖對(duì)肺切除術(shù)后并發(fā)癥發(fā)生的影響. 中國(guó)胸心血管外科臨床雜志, 2013, 20(1): 74-78. doi: 復(fù)制

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1.  中華人民共和國(guó)疾病控制司. 中國(guó)成人超重和肥胖癥預(yù)防控制指南. 2003. 2.
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9.  Licker M, Spiliopoulos A, Frey JG, et al. Risk factors for early mortality and major complications following pneumonectomy for non-small cell carcinoma of the lung. Chest, 2002, 121 (6):1890-1897.
10.  Kanasky WF Jr, Anton SD, Rodrigue JR, et al. Impact of body weight on long-term survival after lung transplantation. Chest, 2002, 121 (2):401-406.
11.  Heuer M, Kaiser GM, Kahraman A, et al. Liver transplantation in nonalcoholic steatohepatitis is associated with high mortality  and post-transplant complications:a single-center experience.  Digestion, 2012, 86 (2):107-113.
12.  Lascano CA, Kaidar-Person O, Szomstein S, et al. Challenges of laparoscopic colectomy in the obese patient:a review. Am J Surg, 2006, 192 (3):357-365.
13.  Porter SE, Russell GV, Dews RC, et al. Complications of acetabular fracture surgery in morbidly obese patients. J Orthop Trauma, 2008, 22 (9):589-594.
14.  李世寬, 周巖冰, 周成富, 等. 肥胖對(duì)胃癌患者術(shù)后短期結(jié)局的影響. 中華胃腸外科雜志, 2010, 13 (2):133-137.
15.  Cooper L.Postoperative complications after thoracic surgery in the morbidly obese patient. Anesthesiol Res Pract, 2011, 865634.
16.  Piestrzeniewicz K, Luczak K, Komorowski J, et al. The relationship between leptin and obesity and cardiovascular risk factors in men with acute myocardial infarction. Cardiol J, 2007, 14 (3):252-259.
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18.  Baskin ML, Ard J, Franklin F, et al. Prevalence of obesity in the United States. Obes Rev, 2005, 6 (1):5-7.
19.  Wang Y, Beydoun MA.The obesity epidemic in the United States-gender, age, socioeconomic, racial/ethnic, and geographic characteristics:a systematic review and meta-regression analysis. Epidemiol Rev, 2007, 29:6-28.
20.  Bruce W, Van der Wall H, Peters M, et al. Occurrence of pulmonary thromboembolism immediately after arthroplasty. Nucl Med Commun, 2001, 22 (11):1237-1242.
21.  Ouellette DW, Patocka C. Pulmonary embolism. Emerg Med Clin North Am, 2012, 30 (2):329-375.
22.  Goldhaber SZ, Bounameaux H. Pulmonary embolism and deep vein thrombosis. Lancet, 2012, 379 (9828):1835-1846.
23.  Cushman M. Epidemiology and risk factors for venous thrombosis. Semin Hematol, 2007, 44 (2):62-69.
24.  Gargiulo NJ 3rd, Veith FJ, Lipsitz EC, et al. Experience with inferior vena cava filter placement in patients undergoing open gastric bypass procedures. J Vasc Surg, 2006, 44 (6):1301-1305.
25.  Karunakar MA, Shah SN, Jerabek S. Body mass index as a predictor of complications after operative treatment of acetabular fractures. J Bone Joint Surg Am, 2005, 87 (7):1498-1502.
  1. 1.  中華人民共和國(guó)疾病控制司. 中國(guó)成人超重和肥胖癥預(yù)防控制指南. 2003. 2.
  2. 2.  趙文華, 翟屹, 胡建平, 等. 中國(guó)超重和肥胖造成相關(guān)慢性疾病的經(jīng)濟(jì)負(fù)擔(dān)研究. 中華流行病學(xué)雜志, 2006, 27 (7):555-559.
  3. 3.  雷藝炎, 陳振光, 羅紅鶴, 等. 肺癌患者圍術(shù)期并發(fā)癥發(fā)生的危險(xiǎn)因素分析. 中國(guó)胸心血管外科臨床雜志, 2008, 15 (4):268-271.
  4. 4.  王邵華, 阮征, 鄭健, 等. 肺切除術(shù)后肺部并發(fā)癥發(fā)生的危險(xiǎn)因素分析. 中國(guó)胸心血管外科臨床雜志, 2010, 17 (4):301-306.
  5. 5.  馬柱, 李德生, 阿不都艾尼?吐?tīng)柡椋?等. 生理學(xué)和手術(shù)侵襲度評(píng)分在肺癌手術(shù)風(fēng)險(xiǎn)預(yù)測(cè)中的應(yīng)用. 中國(guó)胸心血管外科臨床雜志, 2012, 19 (1):31-35.
  6. 6.  Myrdal G, Gustafsson G, Lambe M, et al. Outcome after lung cancer surgery. Factors predicting early mortality and major morbidity. Eur J Cardiothorac Surg, 2001, 20 (4):694-699.
  7. 7.  Kalathiya RJ, Saha SP. Pneumonectomy for non-small cell lung Cancer:outcomes analysis. South Med J, 2012, 105 (7):350-354.
  8. 8.  Menna C, Ciccone AM, Ibrahim M, et al. Pneumonectomy:quality of life and long-term results. Minerva Chir, 2012, 67 (3):219-226.
  9. 9.  Licker M, Spiliopoulos A, Frey JG, et al. Risk factors for early mortality and major complications following pneumonectomy for non-small cell carcinoma of the lung. Chest, 2002, 121 (6):1890-1897.
  10. 10.  Kanasky WF Jr, Anton SD, Rodrigue JR, et al. Impact of body weight on long-term survival after lung transplantation. Chest, 2002, 121 (2):401-406.
  11. 11.  Heuer M, Kaiser GM, Kahraman A, et al. Liver transplantation in nonalcoholic steatohepatitis is associated with high mortality  and post-transplant complications:a single-center experience.  Digestion, 2012, 86 (2):107-113.
  12. 12.  Lascano CA, Kaidar-Person O, Szomstein S, et al. Challenges of laparoscopic colectomy in the obese patient:a review. Am J Surg, 2006, 192 (3):357-365.
  13. 13.  Porter SE, Russell GV, Dews RC, et al. Complications of acetabular fracture surgery in morbidly obese patients. J Orthop Trauma, 2008, 22 (9):589-594.
  14. 14.  李世寬, 周巖冰, 周成富, 等. 肥胖對(duì)胃癌患者術(shù)后短期結(jié)局的影響. 中華胃腸外科雜志, 2010, 13 (2):133-137.
  15. 15.  Cooper L.Postoperative complications after thoracic surgery in the morbidly obese patient. Anesthesiol Res Pract, 2011, 865634.
  16. 16.  Piestrzeniewicz K, Luczak K, Komorowski J, et al. The relationship between leptin and obesity and cardiovascular risk factors in men with acute myocardial infarction. Cardiol J, 2007, 14 (3):252-259.
  17. 17.  Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999-2000. JAMA, 2002, 288 (14):1723-1727.
  18. 18.  Baskin ML, Ard J, Franklin F, et al. Prevalence of obesity in the United States. Obes Rev, 2005, 6 (1):5-7.
  19. 19.  Wang Y, Beydoun MA.The obesity epidemic in the United States-gender, age, socioeconomic, racial/ethnic, and geographic characteristics:a systematic review and meta-regression analysis. Epidemiol Rev, 2007, 29:6-28.
  20. 20.  Bruce W, Van der Wall H, Peters M, et al. Occurrence of pulmonary thromboembolism immediately after arthroplasty. Nucl Med Commun, 2001, 22 (11):1237-1242.
  21. 21.  Ouellette DW, Patocka C. Pulmonary embolism. Emerg Med Clin North Am, 2012, 30 (2):329-375.
  22. 22.  Goldhaber SZ, Bounameaux H. Pulmonary embolism and deep vein thrombosis. Lancet, 2012, 379 (9828):1835-1846.
  23. 23.  Cushman M. Epidemiology and risk factors for venous thrombosis. Semin Hematol, 2007, 44 (2):62-69.
  24. 24.  Gargiulo NJ 3rd, Veith FJ, Lipsitz EC, et al. Experience with inferior vena cava filter placement in patients undergoing open gastric bypass procedures. J Vasc Surg, 2006, 44 (6):1301-1305.
  25. 25.  Karunakar MA, Shah SN, Jerabek S. Body mass index as a predictor of complications after operative treatment of acetabular fractures. J Bone Joint Surg Am, 2005, 87 (7):1498-1502.