Analysis of risk factors for pulmonary complications in patients with spontaneous pneumothorax after micro single-port video-assisted thoracoscopic surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 YUAN Jinquan , WANG Xiaokang , HUANG Zixuan

Department of Cardiothoracic Surgery, Songshan Lake Central Hospital of Dongguan City, Dongguan, 523323, Guangdong, P. R. China;

Corresponding?author：

YUAN Jinquan, Email: hongxiping1@163.com

Keywords：

Spontaneous pneumothorax; single-port; video-assisted thoracoscopic surgery; postoperative pulmonary complications; risk factors

DOI：

10.7507/1007-4848.202008029

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Objective To analyze the occurrence of postoperative pulmonary complications (PPC) and the risk factors in patients with spontaneous pneumothorax who underwent micro single-port video-assisted thoracoscopic surgery (VATS).Methods A total of 158 patients with spontaneous pneumothorax who underwent micro single-port VATS in our hospital from April 2017 to December 2019 were retrospectively included, including 99 males and 59 females, with an average age of 40.53±9.97 years. The patients were divided into a PPC group (n=21) and a non-PPC group (n=137) according to whether PPC occurred after the operation, and the risk factors for the occurrence of PPC were analyzed.Results All 158 patients successfully completed the micro single-port VATS, and there was no intraoperative death. The postoperative chest tightness, chest pain, and dyspnea symptoms basically disappeared. During the postoperative period, there were 3 patients of pulmonary infection, 7 patients of atelectasis, 4 patients of pulmonary leak, 6 patients of pleural effusion, 1 patient of atelectasis and pleural effusion, and the incidence of PPC was 13.29% (21/158). Multivariate logistic regression analysis showed that lung disease [OR=32.404, 95%CI (2.717, 386.452), P=0.006], preoperative albumin level≤35 g/L [OR=14.912, 95%CI (1.719, 129.353), P=0.014], severe pleural adhesions [OR=26.023, 95%CI (3.294, 205.557), P=0.002], pain grade Ⅱ-Ⅲ 24 hours after the surgery [OR=64.024, 95%CI (3.606, 1 136.677), P=0.005] , age [OR=1.195, 95%CI (1.065, 1.342), P=0.002], intraoperative blood loss [OR=1.087, 95%CI (1.018, 1.162), P=0.013] were the risk factors for PPC after micro single-port VATS.Conclusion There is a close relationship between PPC after micro single-port VATS and perioperative indexes in patients with spontaneous pneumothorax. Clinically, targeted prevention and treatment can be implemented according to the age, pulmonary disease, preoperative albumin level, intraoperative blood loss, degree of pleural adhesion and pain grading 24 hours after surgery.

Citation： YUAN Jinquan, WANG Xiaokang, HUANG Zixuan. Analysis of risk factors for pulmonary complications in patients with spontaneous pneumothorax after micro single-port video-assisted thoracoscopic surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(2): 194-199. doi: 10.7507/1007-4848.202008029 Copy

1.	周益民, 劉永京. 微小單孔VATS治療老年原發性氣胸及術后血清TNF-α、IL-1、hs-CRP的變化. 新疆醫科大學學報, 2020, 43(2): 208-211.
2.	Daemen JHT, Lozekoot PWJ, Maessen JG, et al. Chest tube drainage versus video-assisted thoracoscopic surgery for a first episode of primary spontaneous pneumothorax: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2019, 56(5): 819-829.
3.	Kaufmann KB, Loop T, Heinrich S, et al. Risk factors for post-operative pulmonary complications in lung cancer patients after video-assisted thoracoscopic lung resection: Results of the German Thorax Registry. Acta Anaesthesiol Scand, 2019, 63(8): 1009-1018.
4.	Cossu A, Martin Rother MD, Kusmirek JE, et al. Imaging early postoperative complications of cardiothoracic surgery. Radiol Clin North Am, 2020, 58(1): 133-150.
5.	王天佑, 胸外科圍手術期肺保護中國專家共識(2019版)專家組, 中國醫學基金會胸外科專業委員會. 胸外科圍手術期肺保護中國專家共識(2019版). 中國胸心血管外科臨床雜志, 2019, 26(9): 835-842.
6.	肖鵬, 張曉, 靳超. 電視胸腔鏡手術下應用切割縫合器和縫扎術治療自發性氣胸患者的療效分析. 中國內鏡雜志, 2018, 24(4): 46-50.
7.	張勝強, 張洪艷, 王晴, 等. 雙肺通氣經乳暈單孔胸腔鏡治療男性自發性氣胸. 中國微創外科雜志, 2018, 18(1): 82-83.
8.	Karcioglu O, Topacoglu H, Dikme O, et al. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med, 2018, 36(4): 707-714.
9.	辛少偉, 王濤, 辛向兵, 等. 電視胸腔鏡治療創傷性血胸后并發癥發生的危險因素分析. 中華創傷雜志, 2020, 36(7): 619-623.
10.	Li X, Wang X, Zhang H, et al. Unilateral single-port thoracoscopic surgery for bilateral pneumothorax or pulmonary bullae. J Cardiothorac Surg, 2019, 14(1): 71.
11.	周靜, 孫仲濤, 陳曉. 單孔胸腔鏡手術與傳統胸腔鏡手術在自發性氣胸治療中的療效觀察. 中華全科醫學, 2018, 16(8): 1279-1282.
12.	Ye Z, Zhang B, Chen Y, et al. Comparison of single utility port video-assisted thoracoscopic surgery (VATS) and three-port VATS for non-small cell lung cancer. Oncol Lett, 2019, 18(2): 1311-1317.
13.	李曉明, 楊廣義, 張艷峰, 等. 胸腔鏡治療自發性氣胸患者肺部并發癥的相關因素分析. 臨床肺科雜志, 2018, 23(3): 501-503, 507.
14.	Li X, Chen C, Wei X, et al. Retrospective comparative study on postoperative pulmonary complications after orthotopic liver transplantation using the melbourne group scale (MGS-2) diagnostic criteria. Ann Transplant, 2018, 23(1): 377-386.
15.	Numata T, Nakayama K, Fujii S, et al. Risk factors of postoperative pulmonary complications in patients with asthma and COPD. BMC Pulm Med, 2018, 18(1): 4.
16.	Li P, Li J, Lai Y, et al. Perioperative changes of serum albumin are a predictor of postoperative pulmonary complications in lung cancer patients: A retrospective cohort study. J Thorac Dis, 2018, 10(10): 5755-5763.
17.	Chen Y, Wu G, Wang R, et al. Preoperative albumin level serves as a predictor for postoperative pulmonary complications following elective laparoscopic gastrectomy. Curr Pharm Des, 2018, 24(27): 3250-3255.
18.	梁吉振, 韓孔啟, 宮心明, 等. 3種胸腔鏡微創術式治療肺大皰價值比較. 安徽醫學, 2018, 39(10): 1232-1235.
19.	楊震, 閆天生, 彭京平. 自發性氣胸的電視胸腔鏡手術治療進展. 中國胸心血管外科臨床雜志, 2018, 25(8): 724-727.
20.	彭珊, 程小敏. 手術室術中保溫對老年股骨骨折患者出血量、體溫及術后凝血功能的影響. 血栓與止血學, 2019, 25(1): 145-147.
21.	劉宗昂, 張蘇寧. 人工氣胸下胸腔鏡在胸腺瘤切除術中的應用. 中國醫科大學學報, 2019, 48(5): 461-463.
22.	Matsumoto R, Takamori S, Yokoyama S, et al. Lung function in the late postoperative phase and influencing factors in patients undergoing pulmonary lobectomy. J Thorac Dis, 2018, 10(5): 2916-2923.
23.	李仁鵬, 黎琰, 胡文滕, 等. 無管化單孔胸腔鏡肺大皰切除術治療自發性氣胸18例. 中國微創外科雜志, 2019, 19(10): 942-944.
24.	康珀銘. 單孔胸腔鏡肺大皰切除術治療自發性氣胸的療效及中期隨訪研究. 基因組學與應用生物學, 2019, 38(7): 3376-3382.
25.	Shalhub S, Neptune E, Sanchez DE, et al. Spontaneous pneumothorax and hemothorax frequently precede the arterial and intestinal complications of vascular Ehlers-Danlos syndrome. Am J Med Genet A, 2019, 179(5): 797-802.

1. 周益民, 劉永京. 微小單孔VATS治療老年原發性氣胸及術后血清TNF-α、IL-1、hs-CRP的變化. 新疆醫科大學學報, 2020, 43(2): 208-211.
2. Daemen JHT, Lozekoot PWJ, Maessen JG, et al. Chest tube drainage versus video-assisted thoracoscopic surgery for a first episode of primary spontaneous pneumothorax: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2019, 56(5): 819-829.
3. Kaufmann KB, Loop T, Heinrich S, et al. Risk factors for post-operative pulmonary complications in lung cancer patients after video-assisted thoracoscopic lung resection: Results of the German Thorax Registry. Acta Anaesthesiol Scand, 2019, 63(8): 1009-1018.
4. Cossu A, Martin Rother MD, Kusmirek JE, et al. Imaging early postoperative complications of cardiothoracic surgery. Radiol Clin North Am, 2020, 58(1): 133-150.
5. 王天佑, 胸外科圍手術期肺保護中國專家共識(2019版)專家組, 中國醫學基金會胸外科專業委員會. 胸外科圍手術期肺保護中國專家共識(2019版). 中國胸心血管外科臨床雜志, 2019, 26(9): 835-842.
6. 肖鵬, 張曉, 靳超. 電視胸腔鏡手術下應用切割縫合器和縫扎術治療自發性氣胸患者的療效分析. 中國內鏡雜志, 2018, 24(4): 46-50.
7. 張勝強, 張洪艷, 王晴, 等. 雙肺通氣經乳暈單孔胸腔鏡治療男性自發性氣胸. 中國微創外科雜志, 2018, 18(1): 82-83.
8. Karcioglu O, Topacoglu H, Dikme O, et al. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med, 2018, 36(4): 707-714.
9. 辛少偉, 王濤, 辛向兵, 等. 電視胸腔鏡治療創傷性血胸后并發癥發生的危險因素分析. 中華創傷雜志, 2020, 36(7): 619-623.
10. Li X, Wang X, Zhang H, et al. Unilateral single-port thoracoscopic surgery for bilateral pneumothorax or pulmonary bullae. J Cardiothorac Surg, 2019, 14(1): 71.
11. 周靜, 孫仲濤, 陳曉. 單孔胸腔鏡手術與傳統胸腔鏡手術在自發性氣胸治療中的療效觀察. 中華全科醫學, 2018, 16(8): 1279-1282.
12. Ye Z, Zhang B, Chen Y, et al. Comparison of single utility port video-assisted thoracoscopic surgery (VATS) and three-port VATS for non-small cell lung cancer. Oncol Lett, 2019, 18(2): 1311-1317.
13. 李曉明, 楊廣義, 張艷峰, 等. 胸腔鏡治療自發性氣胸患者肺部并發癥的相關因素分析. 臨床肺科雜志, 2018, 23(3): 501-503, 507.
14. Li X, Chen C, Wei X, et al. Retrospective comparative study on postoperative pulmonary complications after orthotopic liver transplantation using the melbourne group scale (MGS-2) diagnostic criteria. Ann Transplant, 2018, 23(1): 377-386.
15. Numata T, Nakayama K, Fujii S, et al. Risk factors of postoperative pulmonary complications in patients with asthma and COPD. BMC Pulm Med, 2018, 18(1): 4.
16. Li P, Li J, Lai Y, et al. Perioperative changes of serum albumin are a predictor of postoperative pulmonary complications in lung cancer patients: A retrospective cohort study. J Thorac Dis, 2018, 10(10): 5755-5763.
17. Chen Y, Wu G, Wang R, et al. Preoperative albumin level serves as a predictor for postoperative pulmonary complications following elective laparoscopic gastrectomy. Curr Pharm Des, 2018, 24(27): 3250-3255.
18. 梁吉振, 韓孔啟, 宮心明, 等. 3種胸腔鏡微創術式治療肺大皰價值比較. 安徽醫學, 2018, 39(10): 1232-1235.
19. 楊震, 閆天生, 彭京平. 自發性氣胸的電視胸腔鏡手術治療進展. 中國胸心血管外科臨床雜志, 2018, 25(8): 724-727.
20. 彭珊, 程小敏. 手術室術中保溫對老年股骨骨折患者出血量、體溫及術后凝血功能的影響. 血栓與止血學, 2019, 25(1): 145-147.
21. 劉宗昂, 張蘇寧. 人工氣胸下胸腔鏡在胸腺瘤切除術中的應用. 中國醫科大學學報, 2019, 48(5): 461-463.
22. Matsumoto R, Takamori S, Yokoyama S, et al. Lung function in the late postoperative phase and influencing factors in patients undergoing pulmonary lobectomy. J Thorac Dis, 2018, 10(5): 2916-2923.
23. 李仁鵬, 黎琰, 胡文滕, 等. 無管化單孔胸腔鏡肺大皰切除術治療自發性氣胸18例. 中國微創外科雜志, 2019, 19(10): 942-944.
24. 康珀銘. 單孔胸腔鏡肺大皰切除術治療自發性氣胸的療效及中期隨訪研究. 基因組學與應用生物學, 2019, 38(7): 3376-3382.
25. Shalhub S, Neptune E, Sanchez DE, et al. Spontaneous pneumothorax and hemothorax frequently precede the arterial and intestinal complications of vascular Ehlers-Danlos syndrome. Am J Med Genet A, 2019, 179(5): 797-802.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of risk factors for pulmonary complications in patients with spontaneous pneumothorax after micro single-port video-assisted thoracoscopic surgery

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