Takagi Keigo, Hata Yoshinobu, Sasamoto Shuichi, Tamaki Kazuyoshi, Fukumori Kazuhiko, Otsuka Hajime, Hasegawa Chiyoko, Shibuya Kazutoshi
Department of Chest Surgery, Toho University Medical Center Omori Hospital, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2010 Aug;16(1):21-5.
The purpose of this study is to retrospectively examine the postoperative pulmonary fistula as a complication after the use of either electrocautery or a harmonic scalpel without stapling devices.
The subjects of this study consisted of 28 patients who received a segmentectomy for a pulmonary malignant tumor, 25 cases of lung cancer and 3 of metastatic lung tumor. The electrocautery was used in 17 patients (EC group) and the harmonic scalpel in 11 (HS group). The levels of postoperative air leakage and postoperative complications were examined among the two groups retrospectively. The histological findings of the cut surface of the segmentectomy by electrocautery and harmonic scalpel were also examined.
Hemostasis and air leakage both were well controlled during the operation, and the postoperative drainage period was short. No major postoperative complications occurred, and all patients began walking in the early postoperative days. However, 1 to 3 postoperative months after discharge, 8 patients showed late onset of a pulmonary fistula, 3 of the 17 (18%) in the EC group and 5 of the 11 (45%) in the HS group. The histological findings of the cut surface of the segmentectomy showed that most of the layer of coagulation necrosis by the harmonic scalpel measured 2 mm thick, and it was denser than that cut from electrocautery. The lumen of the bronchus markedly decreased in size, but it remained, as it also did under the effects of electrocautery.
In the months following the operation, the incidence of the late onset of a pulmonary fistula was higher when the harmonic scalpel was used. It was believed that the small bronchial stump could not tolerate the airway pressure because the thick coagulation necrosis delayed healing of the postoperative wound. It was necessary to ligate the stump of a small bronchus, even though the stump had been temporally closed by coagulation necrosis with the electrocautery or harmonic scalpel during the operation.
本研究旨在回顾性研究在不使用吻合器的情况下，使用电灼或超声刀后作为并发症的术后肺瘘情况。
本研究的对象包括28例行肺恶性肿瘤肺段切除术的患者，其中25例为肺癌，3例为肺转移瘤。17例患者使用电灼（EC组），11例患者使用超声刀（HS组）。回顾性比较两组患者的术后漏气情况及术后并发症。同时，对电灼和超声刀肺段切除标本切面的组织学结果进行检查。
手术过程中止血和漏气均得到良好控制，术后引流时间短。未发生重大术后并发症，所有患者术后早期即可行走。然而，出院后1至3个月，8例患者出现迟发性肺瘘，EC组17例中有3例（18%），HS组11例中有5例（45%）。肺段切除标本切面的组织学结果显示，超声刀造成的凝固性坏死层大部分厚2mm，比电灼造成的更致密。支气管管腔明显缩小，但仍存在，电灼时也有类似情况。
术后数月，使用超声刀时迟发性肺瘘的发生率更高。据信，由于凝固性坏死增厚延迟了术后伤口愈合，小支气管残端无法耐受气道压力。即使在手术中电灼或超声刀已通过凝固性坏死暂时封闭残端，仍有必要结扎小支气管残端。
