单门静脉胸腔镜手术节段切除术中胸膜粘连和围手术期结局的年龄相关差异

摘要(中文译文)

高龄常与肺切除术中技术难度增加相关；然而，肺段切除术中年龄相关手术负担的机制仍不明确。本研究旨在评估接受单孔电视辅助胸腔镜手术（VATS）肺段切除术治疗肺癌的患者中，胸膜粘连、手术复杂性及围手术期结局的年龄相关差异。回顾性分析连续接受单孔VATS肺段切除术的患者。按年龄将患者分为两组（<70岁和≥70岁）。比较两组基线特征、影像学与术中所见、胸膜粘连状态及术后结局。胸膜粘连分为无粘连、部分粘连或广泛粘连。连续变量根据情况采用Student t检验或Wilcoxon秩和检验进行比较。采用多变量logistic回归分析确定胸膜粘连的独立预测因素。共纳入814例患者，其中683例年龄<70岁，131例年龄≥70岁。年龄≥70岁患者胸膜粘连发生率显著高于年龄<70岁患者（26.7% vs 8.8%，P<0.001），广泛胸膜粘连在老年组中也更常见（5.3% vs 1.8%，P=0.02）。多变量分析中，年龄仍与胸膜粘连独立相关（每增加1岁，校正OR 1.11，95% CI：1.08-1.14，P<0.001）。年龄≥70岁患者手术负担更重，手术时间更长（中位数91 vs 89分钟，P=0.002），术后胸管留置时间更长{中位数[四分位距]：1[1-3] vs 1[1-1]天，P<0.001}。老年组术后并发症发生率显著更高（12.2% vs 3.8%，P<0.001），包括持续性肺漏气发生率更高。两组手术切缘距离相当。接受单孔VATS肺段切除术的老年患者胸膜粘连发生率显著更高，并与更长的手术时间和术后引流时间以及更高的并发症发生率相关。尽管如此，仍可获得可接受的术后结局，支持在经过仔细选择的老年患者中行肺段切除术的可行性。

Abstract

Advanced age is often associated with increased technical difficulty during lung resection; however, the mechanisms underlying age-related operative burden during segmentectomy remain unclear. This study aimed to evaluate age-related differences in pleural adhesion, operative complexity, and perioperative outcomes in patients undergoing uniportal video-assisted thoracoscopic surgery (VATS) segmentectomy for lung cancer. Consecutive patients who underwent uniportal VATS segmentectomy were retrospectively reviewed. Patients were stratified into two groups according to age (<70 ≥70 years). Baseline characteristics, radiologic and operative findings, pleural adhesion status, and postoperative outcomes were compared between the groups. Pleural adhesion was categorized as absent, partial, or whole. Continuous variables were compared using the Student's t-test or Wilcoxon rank-sum test, as appropriate. Multivariable logistic regression was performed to identify independent predictors of pleural adhesion. A total of 814 patients were included, of whom 683 were aged <70 years and 131 were aged ≥70 years. Pleural adhesion was significantly more frequent in patients aged ≥70 years than in those aged <70 years (26.7% 8.8%, P<0.001), and whole pleural adhesion was also more common in the elderly group (5.3% 1.8%, P=0.02). In multivariable analysis, age remained independently associated with pleural adhesion (adjusted OR 1.11 per year increase, 95% CI: 1.08-1.14, P<0.001). Patients aged ≥70 years demonstrated greater operative burden, with longer operative time (median 91 89 minutes, P=0.002) and longer postoperative chest tube duration {median [interquartile range]: 1 [1-3] 1 [1-1] days, P<0.001}. The incidence of postoperative complications was significantly higher in the elderly group (12.2% 3.8%, P<0.001), including a higher rate of prolonged air leak. Surgical margin distance was comparable between the two groups. Elderly patients undergoing uniportal VATS segmentectomy exhibited a significantly higher incidence of pleural adhesion and were associated with longer operative time and postoperative drainage, as well as higher complication rates. Nevertheless, acceptable postoperative outcomes can be achieved, supporting the feasibility of segmentectomy in carefully selected elderly patients.

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