目的 探讨影响成年胰腺癌患者术后肺部并发症发生的相关危险因素。方法 研究根据纳排标准有效纳入1162例患者，通过临床电子系统数据库进行回顾性数据检索，收集围手术期相关资料。计算全身炎症指数(Systemic inflammatory index, SII)、预后营养指数(prognostic nutritional index, PNI)、中性粒细胞-淋巴细胞比值(neutrophil-lymphocyte ratio, NLR)、血小板-淋巴细胞比值(platelet-lymphocyte ratio, PLR)和淋巴细胞-单核细胞比值(lymphocyte-monocyte ratio, LMR)，以描述术前患者炎症状态及营养情况。采用logistics回归分析确定危险因素，进行ROC曲线分析模型预测价值，并采用多因素Cox回归探讨患者术后30天生存情况。结果 最终有效纳入的胰腺癌患者中发生术后肺部并发症（Postoperative pulmonary complications, PPCs）的有39例(3.4%)。采用logstics回归分析进行PPCs的危险因素建模，结果出血量、SII、NLR、PLR、中性粒细胞计数及百分比成为独立危险因素。Cox生存分析发现出血量(P=0.031, OR=1.616, 95% CI=1.045-2.500)、SII(P=0.047, OR=1.004, 95% CI=1.000-1.007)、PLR(P=0.016, OR=0.961, 95% CI=0.931-0.993)及术后肺部并发症(P＜0.001, OR=0.018, 95% CI=0.002-0.138)与术后30天患者死亡呈正相关。结论 研究确定术中出血量、术前SII、术前NLR、术前PLR及术前中性粒细胞计数和百分比是PPCs发生的独立危险因素。今后需进一步尝试正常化这些因素，以降低PPCs的发生率。
Objective To explore the risk factors related to postoperative pulmonary complications in adult patients with pancreatic cancer.Method The study effectively included 1162 patients according to the nano-pathology standard. Retrospective data retrieval was conducted through the clinical electronic system database to collect relevant data during the perioperative period. Systemic inflammatory index (SII), prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) were calculated to describe the inflammatory status and nutritional status of patients before operation. Logistic regression analysis was used to determine the risk factors, ROC curve analysis model was used to predict the value, and multivariate Cox regression was used to explore the survival of patients 30 days after surgery.Result PPCs occurred in 39 (3.4%) of the pancreatic cancer patients eventually included. The risk factors of PPCs were modeled based on logstics regression analysis. As a result, blood loss, SII, NLR, PLR, neutrophils count and percentage became independent risk factors. Cox survival analysis showed blood loss (P=0.031, OR=1.616, 95%CI =1.045-2.500), SII(P=0.047, OR=1.004, 95%CI =1.000-1.007), PLR(P=0.016, OR=0.961, 95% CI=0.931-0.993) and postoperative pulmonary complications (P=0.000, OR=0.018, 95% CI=0.002-0.138) were positively correlated with death 30 days after surgery.Conclusion The amount of intraoperative blood loss, preoperative SII, preoperative NLR, preoperative PLR, and preoperative neutrophil count and percentage were identified as independent risk factors for PPC. Further attempts to normalize these factors are needed in the future to reduce the incidence of PPCs.
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