Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
J Thorac Cardiovasc Surg. 2010 Apr;139(4):1007-11. doi: 10.1016/j.jtcvs.2009.07.023. Epub 2009 Aug 15.
For major pulmonary resections, the incidence of prolonged air leak may be highest after right upper lobectomy. Dissection through an incomplete minor fissure for pulmonary artery exposure may contribute to air leak. We evaluate the efficacy of the anterior fissureless technique in decreasing the incidence of prolonged air leak after right upper lobectomy.
Twenty-seven consecutive patients had right upper lobectomy by the classic technique of fissure dissection for pulmonary artery exposure (group A). The next 66 patients had right upper lobectomy by the anterior fissureless technique (group B).
During the period of group A, we observed a higher incidence of prolonged air leak [22.2% (6/27) vs 6.5% (3/46), P = .049] and an increase in hospitalization days (mean 14.8 vs 8.7 days, P = .021) after right upper lobectomy as compared with all other lobar resections. Comparing the 2 techniques for right upper lobectomy (group A vs group B), there was no difference in patient characteristics, operative characteristics, morbidity, or mortality. However, there was a difference in the time to air leak cessation (log-rank P = .002), incidence of prolonged air leak [22.2% (6/27) vs 7.6% (5/66), P = .047], days with chest tube (mean 9.7 vs 6.6 days, P = .044), and days in hospital (mean 14.8 vs 8.2 days, P = .001) favoring group B. No other factors predicted prolonged air leak after right upper lobectomy.
The anterior fissureless technique decreases the duration of air leak, incidence of prolonged air leak, days with chest tube, and days in hospital without any noted disadvantages. This technique should be considered when performing right upper lobectomy.
对于肺大切除术，右上肺叶切除术后发生持续性漏气的发生率可能最高。通过不完全的小裂孔解剖肺动脉显露可能会导致漏气。我们评估前裂无技术在减少右上肺叶切除术后持续性漏气发生率方面的疗效。
27 例连续患者采用经典的小裂孔解剖肺动脉显露技术（A 组）进行右上肺叶切除术。接下来的 66 例患者采用前裂无技术（B 组）进行右上肺叶切除术。
在 A 组期间，与所有其他肺叶切除术相比，我们观察到右上肺叶切除术后持续性漏气的发生率较高[22.2%（6/27）与 6.5%（3/46），P =.049]和住院天数增加（平均 14.8 天与 8.7 天，P =.021）。将这两种技术用于右上肺叶切除术（A 组与 B 组）比较，患者特征、手术特征、发病率或死亡率无差异。然而，在漏气停止时间（对数秩检验 P =.002）、持续性漏气发生率[22.2%（6/27）与 7.6%（5/66），P =.047]、胸腔引流管留置天数（平均 9.7 天与 6.6 天，P =.044）和住院天数（平均 14.8 天与 8.2 天，P =.001）方面存在差异，B 组更有利。没有其他因素预测右上肺叶切除术后持续性漏气。
前裂无技术可减少漏气持续时间、持续性漏气发生率、胸腔引流管留置天数和住院天数，而无明显不利影响。在进行右上肺叶切除术时，应考虑该技术。
