Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
Eur J Cardiothorac Surg. 2010 May;37(5):1209-14. doi: 10.1016/j.ejcts.2009.11.016. Epub 2009 Dec 21.
Predicted postoperative forced expiratory volume in 1s (ppoFEV1) is estimated in lung cancer patients before pulmonary resection, as well as the clinical stage. This study aims to evaluate ppoFEV1 and ppo-vital capacity (ppoVC) on postoperative day 7 (POD7) and to compare the results following video-assisted thoracic surgery (VATS) and open thoracotomy procedures.
Of the 155 patients who underwent pulmonary resection, 70 had VATS; 30 had muscle-sparing thoracotomy (anterior limiting thoracotomy (AL)); and 55 had postero-lateral thoracotomy (PL). VC and FEV1 were measured on POD7 and compared with the VC and FEV1 before surgery using analysis of covariance (ANCOVA). The ratio of the actual- and the ppoVC and FEV1 was evaluated to identify factors associated with variations in postoperative residual VC/FEV1.
There were significant differences by analysis of covariance (ANCOVA) in the VC/FEV1 among the three surgical approaches. In the VATS group, the VC ratio and the FEV1 ratio were 96.5% and 94.7%, respectively; they were significantly higher in the VATS group than in the thoracotomy group (AL: 90.4% and 90.1%, respectively; PL: 87.4% and 87.6%, respectively). Non-chronic obstructive pulmonary disease (COPD) and upper lobectomy were also associated with a low VC ratio and FEV1 ratio.
Predicted postoperative pulmonary function might be overestimated in COPD patients or in those undergoing VATS or lower lobectomy.
在肺癌患者肺切除术前，以及临床分期中，预测术后第 1 秒用力呼气量（ppoFEV1）。本研究旨在评估电视辅助胸腔镜手术（VATS）和开胸手术后第 7 天（POD7）的 ppoFEV1 和 ppo 肺活量（ppoVC），并比较这两种手术方式的结果。
在接受肺切除术的 155 例患者中，70 例行 VATS；30 例行肌保留开胸术（前限开胸术（AL））；55 例行后外侧开胸术（PL）。在 POD7 时测量 VC 和 FEV1，并使用协方差分析（ANCOVA）与术前的 VC 和 FEV1 进行比较。评估实际与预测 VC/FEV1 的比值，以确定与术后残留 VC/FEV1 变化相关的因素。
三种手术方式的 VC/FEV1 差异有统计学意义（ANCOVA）。在 VATS 组中，VC 比值和 FEV1 比值分别为 96.5%和 94.7%；VATS 组明显高于开胸组（AL：分别为 90.4%和 90.1%；PL：分别为 87.4%和 87.6%）。非慢性阻塞性肺疾病（COPD）和上叶切除术也与 VC 比值和 FEV1 比值低有关。
COPD 患者或接受 VATS 或下叶切除术的患者，预测术后肺功能可能被高估。
