Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
Surg Today. 2010 Nov;40(11):1097-9. doi: 10.1007/s00595-009-4173-8. Epub 2010 Nov 3.
It is uncertain whether the dissection of the pulmonary ligament is necessary in patients who undergo an upper lobectomy. A questionnaire was sent to the directors of Thoracic Surgery in 102 hospitals, asking whether dissection of the pulmonary ligament is performed in such patients, and the complications associated with dissecting or preserving the ligament. Seventy-eight directors (76%) returned the questionnaire. The preservation of the ligament is the current practice in 54 hospitals (69%), while 13 hospitals (17%) occasionally dissect, 9 hospitals (11%) regularly dissect, and 2 hospitals (3%) half dissect the ligament. Thirty directors experienced complications which were thought to be associated with dissecting the ligament: bronchial stenosis (21 directors), atelectasis (8), and bronchial obstruction (4). Twenty-six directors described complications thought to be associated with preserving the ligament: the pooling of pleural effusion (19 directors), insufficient expansion of lung (18), atelectasis (8), and empyema (7). Preservation of the ligament may therefore be useful in preventing bronchial stenosis and obstruction, while its dissection may be useful to prevent the pooling of pleural effusion.
在接受肺上叶切除术的患者中，解剖肺韧带是否必要尚不确定。我们向 102 家医院的胸外科主任发放了问卷，询问他们在这些患者中是否解剖肺韧带，以及解剖或保留韧带相关的并发症。78 位主任（76%）回复了问卷。54 家医院（69%）目前的做法是保留韧带，而 13 家医院（17%）偶尔解剖，9 家医院（11%）常规解剖，2 家医院（3%）半解剖韧带。30 位主任经历了与解剖韧带相关的并发症：支气管狭窄（21 位主任）、肺不张（8 位）和支气管阻塞（4 位）。26 位主任描述了与保留韧带相关的并发症：胸腔积液积聚（19 位主任）、肺扩张不全（18 位）、肺不张（8 位）和脓胸（7 位）。因此，保留韧带可能有助于预防支气管狭窄和阻塞，而解剖韧带可能有助于防止胸腔积液积聚。
