Takazakura Ryutaro, Takahashi Masashi, Nitta Norihisa, Sawai Satoru, Tezuka Noriaki, Fujino Shozo, Murata Kiyoshi
Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, 520-2192, Japan.
Radiat Med. 2007 May;25(4):155-63. doi: 10.1007/s11604-007-0119-5. Epub 2007 May 28.
The aim of this study was to assess quantitatively the impairment of diaphragmatic motion after lung resection, with special reference to the location of the resected lobe, duration of the postoperative period, and patient posture. We used magnetic resonance imaging to make the assessments.
In 44 patients (29 men, 15 women; mean age 62.2 years) with lung cancer, diaphragmatic motion was measured during maximum deep, slow breathing using a spoiled gradient-recalled echo sequence before and after lung resection. The study group consisted of 34 patients who were examined using a 1.5-T unit in the supine position and 10 patients using a vertically open 0.5-T unit in both the sitting and supine positions. The influence of surgery site and patient posture on diaphragmatic motion after lung resection was investigated.
In all cases after lung resection, diaphragmatic motion on the operated side was significantly decreased (P < 0.001), and that on the nonoperated side was significantly increased (P = 0.045). After left upper lobectomy and right bilobectomy, the diaphragmatic motion on the operated side was significantly decreased (P < 0.001), and that of the other side was significantly increased (P < 0.001). The diaphragmatic motion was not significantly changed after right middle lobectomy. The diaphragmatic motion on the operated side was impaired significantly more (P = 0.035) in the supine position than in the sitting position.
After lobe resection, diaphragmatic motion was impaired more significantly in the supine than in the sitting position; and it differed according to the location of the resected lobe. The improvement in diaphragmatic function after lobectomy was observed over a period of 3-24 months.
本研究旨在定量评估肺切除术后膈肌运动的受损情况，特别关注切除肺叶的位置、术后时间以及患者体位。我们使用磁共振成像进行评估。
对44例肺癌患者（29例男性，15例女性；平均年龄62.2岁），在肺切除术前和术后，采用扰相梯度回波序列，于最大深度缓慢呼吸时测量膈肌运动。研究组包括34例使用1.5-T设备在仰卧位检查的患者以及10例使用垂直开放式0.5-T设备在坐位和仰卧位检查的患者。研究了手术部位和患者体位对肺切除术后膈肌运动的影响。
在所有肺切除术后病例中，手术侧的膈肌运动明显降低（P < 0.001），而非手术侧的膈肌运动明显增加（P = 0.045）。左上叶切除和右双叶切除术后，手术侧的膈肌运动明显降低（P < 0.001），另一侧的膈肌运动明显增加（P < 0.001）。右中叶切除术后膈肌运动无明显变化。手术侧的膈肌运动在仰卧位比坐位受损更明显（P = 0.035）。
肺叶切除术后，膈肌运动在仰卧位比坐位受损更明显；且根据切除肺叶的位置不同而有所差异。肺叶切除术后膈肌功能在3至24个月内有所改善。
