肺癌患者胸外手术前治疗牙周基础疾病对预防术后肺炎发生的效果评价

doi:10.6040/j.issn.1671-7554.0.2021.1094

摘要/Abstract

摘要： 目的探讨术前牙周病基础治疗对行胸外科手术的肺癌伴牙周疾病者术后肺炎(POP)发生的影响。方法将符合纳入与排除标准、拟接受胸外科手术的肺癌伴牙周疾病患者,分为实验组和对照组。实验组术前行牙周病基础治疗,对照组保持患者原有口腔卫生习惯。两组人群均在术后随访满30 d,分析30 d内的POP发生率及有关因素。结果实验组(n=206)和对照组(n=190)基线特征一致。实验组POP发生率为2.91%,低于对照组14.21%(χ2=16.52,P<0.001)。牙周病基础治疗可以预防POP的发生(OR=0.181,95%CI:0.078~0.411)。术前诊断为牙龈炎、牙周炎的患者,实验组POP发生率均低于对照组(P<0.05)。两组人群中均有随牙周疾病严重程度的增加,POP发生率升高的趋势(P<0.05)。无论行开胸术者(楔形切除、肺叶切除、肺段切除、袖状切除)还是行电视辅助胸腔镜手术者,实验组POP发生率均低于对照组(P<0.05)。结论术前牙周病基础治疗可以降低行胸外科手术的肺癌伴牙周疾病者POP发生率。

关键词: 牙周病基础治疗, 肺癌, 术后肺炎, 临床试验

Abstract: Objective To investigate the effects of periodontal basic therapy on postoperative pneumonia(POP)in patients with lung cancer undergoing thoracic surgery. Methods Patients with lung cancer and periodontal disease who met the inclusion and exclusion criteria were divided into the experimental group and control group. The experimental group received periodontal basic therapy before thoracic surgery, while the control group maintained the oral hygiene habits. All subjects were followed up for 30 days, and the incidence of POP and related factors were analyzed. Results There were 206 cases in the experimental group and 190 cases in the control group. The incidence of POP in the experimental group was 2.91%, which was lower than that in the control group 14.21%(χ2=16.52, P<0.001). Logistic regression results showed that periodontal basic therapy had a protective effect on POP(OR=0.181, 95%CI=0.078-0.411). The incidence of POP in the experimental group was lower than that in the control group(P<0.05)in patients with gingivitis and periodontitis. In both groups, the incidence of POP increased with the severity of periodontal disease(P<0.05). The incidence of POP in the experimental group was significantly lower than that in the control group in those who underwent thoracotomy(wedge resection, lobectomy, segmental resection, sleeve resection)or video-assisted thoracoscopic surgery(P<0.05). Conclusion Periodontal basic therapy can reduce the incidence of POP in patients with lung cancer and periodontal disease before thoracic surgery.

Key words: Periodontal basic therapy, Lung cancer, Postoperative pneumonia, Clinical trial

中图分类号:

R781.4

韩靖,贾春玲. 肺癌患者胸外手术前治疗牙周基础疾病对预防术后肺炎发生的效果评价[J]. 山东大学学报 (医学版), 2022, 60(9): 113-118.

HAN Jing, JIA Chunling. Effects of periodontal basic therapy on postoperative pneumonia in patients with lung cancer before thoracic surgery[J]. Journal of Shandong University (Health Sciences), 2022, 60(9): 113-118.

参考文献

[1] 刘慧敏, 周乾宇, 贾善群, 等. 2004~2018年中国肺癌死亡趋势分析及预测[J]. 中国预防医学杂志, 2021, 22(12): 913-919. LIU Huimin, ZHOU Qianyu, JIA Shanqun, et al. Death trends of lung cancer in China from 2004—2018[J]. Chinese Preventive Medicine, 2021, 22(12): 913-919.
[2] 葛均波, 徐永健, 王辰. 内科学[M].9版. 北京: 人民卫生出版社, 2020.
[3] Yao L, Luo J, Liu L, et al. Risk factors for postoperative pneumonia and prognosis in lung cancer patients after surgery: A retrospective study[J]. Medicine(Baltimore). 2021, 100(13): e25295. doi:10.1097/MD.0000000000025295.
[4] Stéphan F, Boucheseiche S, Hollande J, et al. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors[J]. Chest, 2000, 118(5): 1263-1270.
[5] 中华预防医学会医院感染控制分会第四届委员会,重点部位感染防控学组. 术后肺炎预防和控制专家共识[J]. 中华临床感染病杂志, 2018, 11(1): 11-19. Group of Key Site Infection Control, Nosocomial Infection Control Commission, Chinese Preventive Medicine Association. Expert consensus on prevention and control of postoperative pneumonia[J]. Chinese Journal of Clinical Infectious Diseases, 2018, 11(1): 11-19.
[6] Heo SM, Haase EM, Lesse AJ, et al. Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation[J].Clin Infect Dis, 2008, 47(12): 1562-1570.
[7] Hyung-Suk Yoon, Wanqing Wen, Jirong Long, et al. Association of oral health with lung cancer risk in a low-income population of African Americans and European Americans in the Southeastern United States[J]. Lung Cancer, 2018, 127: 90-95. doi: 10.1016/j.lungcan.2018.11.028.
[8] Jia C, Sun M, Wang W, et al. Effect of oral plaque control on postoperative pneumonia following lung cancer surgery[J]. Thorac Cancer, 2020, 11(6): 1655-1660.
[9] Ishimaru M, Matsui H, Ono S, et al. Preoperative oral care and effect on postoperative complications after major cancer surgery[J]. Br J Surg, 2018, 105(12): 1688-1696.
[10] Iwata E, Hasegawa T, Yamada SI, et al. Effects of perioperative oral care on prevention of postoperative pneumonia after lung resection: multicenter retrospective study with propensity score matching analysis[J]. Surgery, 2019, 165(5): 1003-1007.
[11] Ishimaru M, Matsui H, Ono S, et al. Preoperative oral care and effect on postoperative complications after major cancer surgery[J]. Br J Surg, 2018, 105(12): 1688-1696.
[12] Savardekar A, Gyurmey T, Agarwal R, et al. Incidence, risk factors, and outcome of postoperative pneumonia after microsurgical clipping of ruptured intracranial aneurysms[J]. Surg Neurol Int, 2013, 4: 24. doi: 10.4103/2152-7806.107894.
[13] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China[J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[14] Torre LA, Siegel RL, Ward EM, et al. Global cancer incidence and mortality rates and trends - an update[J]. Cancer Epidemiol Biomarkers Prev, 2016, 25(1): 16-27.
[15] Yang Q, Luo LC, Li FM, et al. Survival outcomes of radiofrequency ablation compared with surgery in patients with early-stage primary non-small-cell lung cancer: a meta-analysis[J]. Respir Investig, 2022, 60(3): 337-344.
[16] 李刚, 王健生, 秦思达, 等. 布地奈德联合氨溴索氧化驱动雾化吸入预防成人开胸术后肺炎的临床疗效[J]. 北京大学学报(医学版), 2018, 50(5): 840-844. LI Gang, WANG Jiansheng, QIN Sida, et al. Clinical study of the oxygen drive aerosol inhalation with budesonide and ambroxol in the prevention of adult post-thoracotomy pneumonia[J]. Journal of Peking University(Health Sciences), 2018, 50(5): 840-844.
[17] Villeneuve PJ. Interventions to avoid pulmonary complications after lung cancer resection[J]. J Thorac Dis, 2018, 10(Suppl 32): S3781-S3788.
[18] Lakoh S, Yi L, Sevalie S, et al. Incidence and risk factors of surgical site infections and related antibiotic resistance in Freetown, Sierra Leone: a prospective cohort study[J]. Antimicrob Resist Infect Control, 2022, 11(1): 39.
[19] 许缤, 陈红岩, 孙嫣, 等. 胸外科手术后医院获得性肺炎危险因素分析[J]. 中华医院感染学杂志, 2012, 22(1): 64-66. XU Bin, CHEN Hongyan, SUN Yan, et al. Risk factors of hospital-acquired pneumonia after thoracic surgery[J]. Chinese Journal of Nosocomiology, 2012, 22(1): 64-66.
[20] Vieira Colombo AP, Magalhães CB, Hartenbach FA, et al. Periodontal-disease-associated biofilm: a reservoir for pathogens of medical importance[J]. Microb Pathog, 2016, 94(5): 27-34.
[21] Nishino T, Yoshida T, Inoue S, et al. Perioperative oral management for esophageal cancer and lung cancer surgery[J]. Nihon Geka Gakkai Zasshi, 2017, 118(2): 155-160.
[22] 孟焕新. 牙周病学[M]. 4版. 北京: 人民卫生出版社, 2022.
[23] Qiu T, Zhao Y, Xuan Y, et al. Robotic sleeve lobectomy for centrally located non-small cell lung cancer: a propensity score-weighted comparison with thoracoscopic and open surgery[J]. J Thorac Cardiovasc Surg, 2020, 160(3): 838-846.
[24] Lewis RJ, Caccavale RJ, Sisler GE, et al. One hundred consecutive patients undergoing video-assisted thoracic operations[J]. Ann Thorac Surg, 1992, 54(3): 421-426.
[25] Rauma V, Andersson S, Robinson EM, et al. Thoracotomy and VATS surgery in local non-small-cell lung cancer: differences in long-term health-related quality of life[J]. Clin Lung Cancer, 2019, 20(5): 378-383.
[26] 张大勇. 电视辅助胸腔镜手术与开胸手术对非小细胞肺癌患者术后免疫功能的影响[J]. 湖南师范大学学报(医学版), 2021, 18(1): 124-127. ZHANG Dayong. The effect of video-assisted thoracoscopic surgery and thoracotomy on postoperative immune function of patients with non-small cell lung cancer[J]. Journal of Hunan Normal University(Medical Sciences), 2021, 18(1): 124-127.

相关文章 15

[1]	山东省药学会. 药物临床试验用药品管理山东专家共识[J]. 山东大学学报 (医学版), 2026, 64(4): 8-13.
[2]	黄佩文, 王旭东. 治疗非小细胞肺癌新药:靶向c-Met蛋白的抗体药物偶联物Telisotuzumab Vedotin[J]. 山东大学学报 (医学版), 2026, 64(3): 124-130.
[3]	赵汉卿,周新睿,李子建,唐兴. 循环肿瘤细胞联合血清学检测在非小细胞肺癌中的应用[J]. 山东大学学报 (医学版), 2025, 63(5): 79-85.
[4]	徐年兴,魏东,乔俊杰,战炳炎. CD8⁺、IL-6和PaO₂对不可切除Ⅲ_B/C和Ⅳ期非小细胞肺癌免疫治疗触发放射召回性肺炎的预测价值[J]. 山东大学学报 (医学版), 2025, 63(2): 29-35.
[5]	山东省腔镜外科质量控制中心胸腔镜委员会. 山东省VATS/RATS非小细胞肺癌围术期质量控制指标专家共识(2025版)[J]. 山东大学学报 (医学版), 2025, 63(12): 1-5.
[6]	李懿原,马珊,李爱华,龙飞. 超声支气管镜引导下碘-125粒子植入治疗肺癌中央区淋巴结转移[J]. 山东大学学报 (医学版), 2025, 63(12): 26-34.
[7]	刘振昆,吕纪玲,徐伟伟,马力天,张才擎. BALF tNGS检测及培养对NSCLC合并IPFD的诊断价值[J]. 山东大学学报 (医学版), 2025, 63(11): 36-45.
[8]	张荣雨,赵文,李洪欣,杨闯,王健,韩春燕,李际盛. 奥西替尼联合化疗一线治疗EGFR-RAD51融合突变转移性肺腺癌1例[J]. 山东大学学报 (医学版), 2024, 62(5): 116-120.
[9]	曹原,张剑桥,孟祥伟,刘文,庞晓明. 治疗慢性鼻窦炎伴鼻息肉的国内药物临床研究现状[J]. 山东大学学报 (医学版), 2024, 62(12): 38-42.
[10]	王亚楠,梁传杰,贾梦琪,苑辉卿. 二硫键异构酶TMX1促进肺癌化疗耐药[J]. 山东大学学报 (医学版), 2023, 61(8): 31-39.
[11]	王蕾,向淇,刘学伍. 伴系统性硬化症、类风湿关节炎的副肿瘤神经综合征1例[J]. 山东大学学报 (医学版), 2023, 61(7): 118-120.
[12]	钟璐,薛付忠. 基于贝叶斯网络不确定性推理的肺癌风险预测模型[J]. 山东大学学报 (医学版), 2023, 61(4): 86-94.
[13]	程传龙,韩闯,房启迪,刘盈,杨淑霞,崔峰,刘靖靖,李秀君. 基于时空地理加权回归模型探索肺癌发病的环境影响因素[J]. 山东大学学报 (医学版), 2023, 61(4): 95-102.
[14]	杨咏青,赵鹏,汪玉,马文静,田迷迷,程亚旎,祖璐,林祥涛. 细胞外容积分数对62例不同病理类型肺癌的诊断价值[J]. 山东大学学报 (医学版), 2023, 61(2): 88-94.
[15]	艾江山,高会江,艾仕文,李恒艳,石国栋,魏煜程. CT影像组学对囊腔型肺癌的诊断价值[J]. 山东大学学报 (医学版), 2023, 61(12): 70-77.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed