摘要
Abstract
Objective To look into the prevalence and risk factors for pulmonary fungal infections in patients who have had open chest surgery for esophageal cancer.Methods Fifty-one patients with pulmonary fungal infections following esophageal cancer thoracotomy in our hospital between May 2021 and November 2024 were chosen as the infection group in a retrospective study,while 153 patients who did not have an infection following esophageal cancer thoracotomy during the same time period were chosen as the non-infection group.Gather clinical information from two patient groups,use a multi-ple logistic regression model to assess the risk factors for pulmonary fungal infection in patients with esophageal cancer fol-lowing open chest surgery,assess the predictive value using receiver operating characteristic(ROC)curves,and build a decision tree model based on risk factors.Results A total of 65 fungal strains were found in 53 esophageal cancer patients who had open chest surgery and pulmonary fungal infections,with Candida albicans making up the largest percentage(39.68%);Age(≥60 years old)was one of the multivariate results.[OR=3.307(95%CI 1.281～8.536)],compli-cated with diabetes[OR=4.975(95%CI 1.730～14.308)],tumor site(upper/middle esophageal segment)[OR=4.480(95%CI 1.596～12.575)],duration of antibiotic treatment(≥14 days)[OR=3.898(95%CI 1.424～10.674)],Operation time(≥240 min)[OR=2.656(95%CI 1.034～6.826)],Duration of postoperative catheteriza-tion(≥7 days)[OR=5.194(95%CI 1.760～15.331)],postoperative WBC(<4.0×109/L)[OR=2.815(95%CI 1.105～7.172)]and postoperative IL-8[OR=1.215(95%CI 1.135～1.330)]were independent risk factors for pulmo-nary fungal infection following esophageal cancer thoracotomy(P<0.05).Following esophageal cancer thoracotomy surgery,ROC analysis revealed that the aforementioned indicators and combined prediction had statistical significance(P<0.05)for the occurrence of pulmonary fungal infection.AUC=0.916,95%CI(0.871～0.960)The combined detec-tion diagnostic efficacy analysis shows a sensitivity of 78.4%and a specificity of 92.8%.With a classification accuracy of 85.3%,the decision tree model demonstrates that the IL-8 level in the first layer is the most significant predictor.Con-clusion Independent risk factors for pulmonary fungal infection following thoracotomy for esophageal cancer include age(≥60 years),combined diabetes,tumor site(upper/middle esophagus),antibiotic treatment duration(≥14 days),oper-ation duration(≥240 min),postoperative catheterization duration(≥7 days),postoperative WBC(<4.0×109/L),and postoperative IL-8.Following thoracotomy for esophageal cancer,the prediction model based on the aforementioned fac-tors plays a guiding role in pulmonary fungal infection.关键词
食管癌/开胸手术/肺部真菌感染/易感因素Key words
esophageal cancer/open chest surgery/pulmonary fungal infection/susceptible factors
