Nonaka M, Yamamoto S, Kataoka D, Bito A, Matsuoka J, Fukuzumi M, Ohno M, Takaba T
Department of Thoracic and Cardiovascular Surgery, Showa University School of Medicine, Tokyo, Japan.
Kyobu Geka. 2005 Jun;58(6):433-8; discussion 438-40.
Respiratory function before and 2 months after lung lobectomy was analyzed associated with resected lobe. Post- or preoperative ratios of FEV1.0 or VC were compared among (1) predicted value by the number of subsegments using bronchofiberscopy, (2) predicted value by the lobar volume ratio using computed tomography (CT), and (3) actually measured value. Using subsegments method, post- or preoperative predicted VC ratios were 85 +/- 1% after right upper lobectomy (RU), 69 +/- 1% after right lower lobetomy (RL), 74 +/- 1% after left upper lobectomy (LU), and 75 +/- 1% after left lower lobectomy (LL). Using CT method, post- or preoperative predicted VC ratios were 80 +/- 2% after RU, 76 +/- 4% after RL, 74 +/- 2% after LU, and 79 +/- 3% after LL. Actually measured post- or preoperative FEV1.0 ratios were 82 +/- 3% after RU, 89 +/- 8% after RL, 73 +/- 3% after LU, and 86 +/- 5% after LL, and the VC ratios were 88 +/- 5% after RU, 79 +/- 3% after RL, 77 +/- 4% after LU, and 94 +/- 3% after LL. In the FEV1.0 analysis using both subsegments method and CT method, the predicted value was correlated with upper lobectomy but was overestimated in case of lower lobectomy. This phenomenon might be caused by the postoperative bronchial branching deformity after upper lobectomy. In the VC analysis using subsegments method, the predicted value was correlated with upper lobectomy but was overestimated in case of lower lobectomy. Meanwhile, in the VC analysis using CT method, the predicted value was correlated with RL or LU but was overestimated in case of RU or LL. This may due to the fact that RL and LU had large lobar volumes. In conclusion, postoperative predicted and actually measured values were different associated with resected lobe. In the FEV1.0 and VC analysis using subsegments method, the predicted value was strongly correlated with upper lobectomy but was overestimated (10%) in case of lower lobectomy.
分析了肺叶切除术前及术后2个月与切除肺叶相关的呼吸功能。比较了(1)使用纤维支气管镜检查的亚段数量得出的预测值、(2)使用计算机断层扫描(CT)的肺叶体积比得出的预测值以及(3)实际测量值之间术前和术后的FEV1.0或VC比值。采用亚段法,右上叶切除(RU)术后或术前预测的VC比值为85±1%,右下叶切除(RL)术后为69±1%,左上叶切除(LU)术后为74±1%,左下叶切除(LL)术后为75±1%。采用CT法,RU术后或术前预测的VC比值为80±2%,RL术后为76±4%,LU术后为74±2%,LL术后为79±3%。实际测量的术前和术后FEV1.0比值在RU术后为82±3%,RL术后为89±8%,LU术后为73±3%,LL术后为86±5%;VC比值在RU术后为88±5%,RL术后为79±3%,LU术后为77±4%,LL术后为94±3%。在同时使用亚段法和CT法的FEV1.0分析中,预测值与上叶切除相关,但在下叶切除时被高估。这种现象可能是由上叶切除术后支气管分支畸形引起的。在使用亚段法的VC分析中,预测值与上叶切除相关,但在下叶切除时被高估。同时,在使用CT法的VC分析中,预测值与RL或LU相关,但在RU或LL时被高估。这可能是因为RL和LU的肺叶体积较大。总之,术后预测值和实际测量值因切除肺叶而异。在使用亚段法的FEV1.0和VC分析中,预测值与上叶切除密切相关,但在下叶切除时被高估(10%)。