Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
Eur J Cardiothorac Surg. 2010 Jun;37(6):1433-7. doi: 10.1016/j.ejcts.2010.01.002. Epub 2010 Feb 11.
Lung segmentectomy reduces the extent of resection required for lobectomy, but its resulting clinical benefits remain controversial.
Forty patients who underwent segmentectomy for stage I lung cancer over a 5-year period were matched to 40 patients who underwent lobectomy, using nearest available matching method with the estimated propensity score. We compared the functional volume of the ipsilateral lung to be resected, the ipsilateral lung to be preserved and the contralateral lung before, and 6 months after the operation, between the groups. Functional lung volume was defined as the lung volume representing normal attenuation (-600 to -910 Hounsfield units (HUs)) on computed tomography. We also compared the volumetric parameters to the spirometric parameters in 42 other patients, who underwent major lung resection for stage I lung cancer.
We removed 11.6% of the functional lung volume by segmentectomy and 24.5% by lobectomy (P<0.001). However, the loss of the functional lung volume after segmentectomy was only 8.3% and that after lobectomy was 9.2%: this difference was not significant (P=0.7). Both the ipsilateral residual lung and the contralateral lung increased in functional volume more extensively after lobectomy than after segmentectomy. Increased postoperative functional lung volume was significantly correlated with improvement in postoperative pulmonary function (R=0.6, P<0.001).
Although lung segmentectomy can reduce the extent of lung resection, it may not contribute to preserving postoperative functional lung volume because lobectomy promotes postoperative expansion of the bilateral residual lung, which compensates postoperative pulmonary functional loss to a greater extent than segmentectomy.
肺段切除术减少了肺叶切除术所需的切除范围，但它所带来的临床获益仍存在争议。
在 5 年期间，对 40 例接受 I 期肺癌肺段切除术的患者进行了回顾性研究，使用最近邻匹配法和估计的倾向评分进行匹配，以匹配 40 例接受肺叶切除术的患者。我们比较了两组患者术前和术后 6 个月患侧需要切除的肺功能容积、需要保留的肺功能容积和对侧肺功能容积。功能性肺容积定义为 CT 上代表正常衰减（-600 至-910 亨氏单位（HU））的肺容积。我们还将 42 例接受 I 期肺癌肺叶切除术的患者的体积参数与肺活量参数进行了比较。
肺段切除术切除了 11.6%的功能性肺容积，肺叶切除术切除了 24.5%（P<0.001）。然而，肺段切除术后功能性肺容积的损失仅为 8.3%，肺叶切除术后为 9.2%：这一差异无统计学意义（P=0.7）。与肺段切除术相比，肺叶切除术术后患侧残留肺和对侧肺的功能性肺容积增加更为明显。术后功能性肺容积的增加与术后肺功能的改善显著相关（R=0.6，P<0.001）。
尽管肺段切除术可以减少肺切除范围，但它可能无助于保留术后功能性肺容积，因为肺叶切除术促进了双侧残留肺的术后扩张，从而比肺段切除术更能补偿术后肺功能的丧失。
