Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
J Surg Res. 2011 May 15;167(2):e71-5. doi: 10.1016/j.jss.2009.11.009. Epub 2009 Nov 27.
We recently introduced a technique of sutureless, mesh-based pneumostasis for preventing alveolar air leaks after lung resection. To verify the clinical usefulness of this technique, we examined if it can contribute to preserving gas exchange capacity and promoting postoperative rehabilitation.
We prospectively collected perioperative data, including arterial oxygen saturation on postoperative day (POD) 1 and the length of postoperative rehabilitation in 100 patients undergoing elective, video-assisted major lung resection for cancer. Before April, 2006, intraoperative air leaks were sealed with the conventional method (control group), and thereafter, with bioabsorbable mesh and glue, without suturing, (treated group). To reduce the bias in comparison of the nonrandomized control group, we paired the treated group with the control group using the nearest available matching method on the estimated propensity score.
Thirty-five patients in the control group were matched to 35 patients in the treated group based on the estimated propensity score. The length of both chest tube drainage and postoperative rehabilitation were significantly shorter in the treated group than in the control group (median, 1 versus 1 d, P = 0.03; 2 versus 3 d, P = 0.01, respectively). The arterial oxygen saturation on POD 1 was significantly higher in the treated group than in the control group (median, 94.0 versus 92.5 %, P = 0.03).
Mesh-based pneumostasis during video-assisted major lung resection enabled early chest tube removal, preserved postoperative oxygenation capacity, and promoted postoperative rehabilitation, which may facilitate fast-track surgery for patients undergoing video-assisted major lung resection for cancer.
我们最近引入了一种无缝线、基于网片的气胸固定技术，以防止肺切除术后肺泡漏气。为了验证该技术的临床实用性，我们研究了它是否有助于保持气体交换能力和促进术后康复。
我们前瞻性地收集了 100 例择期行电视辅助大肺切除术治疗癌症的患者的围手术期数据，包括术后第 1 天的动脉血氧饱和度和术后康复时间。在 2006 年 4 月之前，术中漏气采用常规方法（对照组）密封，此后采用生物可吸收网片和胶水（实验组）进行无缝线密封。为了减少非随机对照研究的偏倚，我们使用最近可用的匹配方法对估计的倾向评分进行配对，将实验组与对照组进行比较。
根据估计的倾向评分，35 例对照组患者与 35 例实验组患者相匹配。实验组的胸腔引流管放置时间和术后康复时间均显著短于对照组（中位数分别为 1 天对 1 天，P = 0.03；2 天对 3 天，P = 0.01）。实验组术后第 1 天的动脉血氧饱和度显著高于对照组（中位数分别为 94.0%对 92.5%，P = 0.03）。
电视辅助大肺切除术中的网片气胸固定术可实现早期拔除胸腔引流管，保持术后氧合能力，促进术后康复，可能有助于接受电视辅助大肺切除术治疗癌症的患者快速康复。
