Evaluation of the Risk Factors Predicting Morbidity and Mortality after Major Pulmonary Resection

주요 폐절제술시 이환율과 사망률을 예견하는 위험인자의 평가

  • Choi, Ho (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Ajou University) ;
  • Lee, Cheol-Joo (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Ajou University) ;
  • Soh, Dong-Moon (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Ajou University) ;
  • Kim, Jung-Tae (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Ajou University) ;
  • Hong, Jun-Wha (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Ajou University) ;
  • Ryu, Han-Young (Department of Thoracic and Cardiovascular Surgery, Pundang Jaesaeng General Hospital) ;
  • Park, Jae-Beom (Department of Occupational and Environmental Medicine, Ajou University)
  • 최호 (아주대학병원 흉부외과) ;
  • 이철주 (아주대학병원 흉부외과) ;
  • 소동문 (아주대학병원 흉부외과) ;
  • 김정태 (아주대학병원 흉부외과) ;
  • 홍준화 (아주대학병원 흉부외과) ;
  • 류한영 (분당재생병원 흉부외과) ;
  • 박재범 (아주대학교 산업의학과)
  • Published : 1999.06.01

Abstract

Background: Patients who are considered for major pulmonary resection are generally evaluated by spirometry and clinical assessment to predict morbidity and mortality. Despite this, none has yet proved to be a convenient and reliable estimate of risk. Material and Method: A retrospective analysis was performed in 167 patients who were diagnosed for lung cancer, bronchiectasis, pulmonary tuberculosis, and other benign pulmonary disease, and who underwent major lung resections. The relationship of 25 preoperative or postoperative variables to 19 postoperative events were classified into categories as operative mortality, pulmonary or cardiovascular morbidity, and other morbidity was assessed. Logistic regression analysis and $\chi$2 analysis were used to identify the relationship of the operative risk factors to the grouped postoperative complications. Result: The best single predictor of complications was the percent predicted postoperative diffusing capacity (pulmonary morbidity, p<0.009; cardiovascular morbidity, p<0.003: overall morbidity, p<0.004). Conclusion: The diffusing capacity of the lung for carbon monoxide was an important predictor of postoperative complications than the spirometry, and it usually should be a part of the evaluation of patients being considered for pulmonary resection.

배경: 폐암을 비롯한 각종 폐질환에 있어서 중요한 외과적 치료방법인 폐절제술시 일반적으로 수술전에 폐기능 검사 및 기타 임상적 평가를 시행하여 수술후에 이환율과 사망율에 영향을 주는 위험 인자를 확인하고 있으나 아직까지 가장 확실하고 정확한 단일 검사방법과 검사치에 대한 기준 설정에는 논란의 여지가 있다. 대상 및 방법: 본 연구는 1994년 6월부터 1998년 2월까지 3년 8개월 동안 아주대학교 병원 흉부외과학 교실에서 폐암, 기관지 확장증, 그리고 폐결핵 등으로 주요 폐 절제술을 시행받은 167명의 환자를 대상으로 25개의 수술전 또는 수술중 위험인자와 19개의 수술후 합병증을 분석하여 그 관련성을 연구하였다. 19개의 수술후 합병증은 사망율 및 호흡기, 순환기, 그리고 기타 합병증 네 가지로 분류하였고 수술전 또는 수술중 위험 인자와의 연관성을 확인하기 위하여 로지스틱 회귀분석과 $\chi$2검정을 사용하였다. 결과: 합병증을 예견하는 인자로 술후 예측 폐확산능백분율(ppoDLCO%)이 호흡기(p<0.009), 순환기(p<0.003), 전체 이환율(p<0.004)에 가장 유의한 영향을 주는 것으로 평가되었다. 결론: 폐기능 검사중 폐확산능(Diffusing Capacity for Carbon Monoxide, DLCO)이 일반적으로 사용되는 페활량측정법(Spirometry) 보다 술후 합병증을 예견하는데 있어서 통계학적으로 유의성있는 인자로 평가되었다. 따라서, 주요 폐절제술의 적응증이 되는 환자들은 폐확산능 검사를 통상적으로 시행하여 술전 정확한 평가에 의하여 유용한 치료의 지침으로 삼아야 될 것으로 판단된다.

Keywords

References

  1. Chest v.59 Clinical coures related to preoperative and postoperative pulmonary function in patients with bronchogenic carcinoma Boushy SE;Billing DM;North LB;Helgason AH
  2. Resp Care v.27 Assesment for lung resection Boysen PG
  3. Am Rev Resp Dis v.119 Preoperative evaluation of pulmonary function: validity, indications and benefits Tisi GM
  4. J Thorac Cardiovasc Surg v.109 Optimizing selection of patients for the major lung resection Ferguson MK;Laurie BR;Rosemarie M
  5. Ann Thorac Surg v.62 Early and late morbidity in patients undergoing pulmonary resection with low diffusing capacity Michael B;Kenneth WP;Joseph HC(et al.)
  6. Am Rev Respir Dis v.103 Spirometric standards for healthy nonsmocking adults Morris JF;Koski A;Johnson LC
  7. Am Rev Tuberc v.79 Respiratory function test: normal valuse at median altitudes and the prediction of normal results Goldman HI;Becklake MR
  8. Arch Environ Health v.12 Evaluation of respiratory impairment Gensler EA;Wright GW
  9. Am Rev Respir Dis v.111 Pulmonary function evaluation of the lung resection candidate : A prospective study Gerald NO
  10. J Thorac Cardiovasc Surg v.55 A bronchoschopirometric method of estimating the effect of pneumonectomy on the maximum breathing capacity Herbert N
  11. Dis Chest v.41 Operative pulmonary artery pressure measurments as a guide to postoperative management and prognosis following pneumonectomy James JR
  12. J Thorac Cardiovasc Surg v.80 Clinical value of quantitative ventilation-perfusion lung scans in the surgical management Jorge AW
  13. Chest v.62 Assesment of operative risk of pneumonectomy Joseph R
  14. J Thorac Cardiovasc Surg v.86 Regional and overall pulmonary function change in the lung cancer Ali MK
  15. Chest v.72 Prospective evaluation for the pneumonectomy using the 99m technetium quantitative perfusion lung scan Philip GB
  16. J Thorac Cardiovasc Surg v.86 Prediction of postoperative pulmonary function following thoracic operation : value of ventilation-perfusion scan Bria WF