Yoshimoto Kentaro, Nomori Hiroaki, Mori Takeshi, Ohba Yasuomi, Shiraishi Kenji, Ikeda Koei
Department of Thoracic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
J Cardiothorac Surg. 2011 Feb 20;6:17. doi: 10.1186/1749-8090-6-17.
For small peripheral c-T1N0M0 non-small cell lung cancers involving multiple segments, we have conducted a resection of subsegments belonging to different segments, i.e. combined subsegmentectomy (CSS), to avoid resection of multiple segments or lobectomy. Tumor size, location of tumor, and forced expiratory volume in 1 second (FEV1) of each preserved lobe were compared among the CSS, resection of single segment, and that of multiple segments.
FEV1 of each preserved lobe were examined in 17 patients who underwent CSS, 56 who underwent resection of single segment, and 41 who underwent resection of multiple segments, by measuring pulmonary function and lung-perfusion single-photon-emission computed tomography and computed tomography before and after surgery.
Tumor size in the CSS was significantly smaller than that in the resection of multiple segments (1.4±0.5 vs. 2.0±0.8 cm, p=0.002). Tumors in the CSS were located in the right upper lobe more frequently than those in the resection of multiple segments (53% vs. 5%, p<0.001). Postoperative of FEV1 of each lobe after the CSS was higher than that after the resection of multiple segments (0.3±0.2 vs. 0.2±0.2 l, p=0.07). Mean FEV1 of each preserved lobe per subsegment after CSS was significantly higher than that after resection of multiple segments (0.05±0.03 vs. 0.03±0.02 l, p=0.02). There was no significant difference of these factors between the CSS and resection of single segment.
The CSS is effective for preserving pulmonary function of each lobe, especially for small sized lung cancer involving multiple segments in the right upper lobe, which has fewer segments than other lobes.
对于累及多个肺段的周围型小c-T1N0M0非小细胞肺癌，我们进行了属于不同肺段的亚段切除术，即联合亚段切除术（CSS），以避免切除多个肺段或肺叶切除术。比较了CSS组、单肺段切除组和多肺段切除组的肿瘤大小、肿瘤位置以及各保留肺叶的一秒用力呼气量（FEV1）。
通过测量术前和术后的肺功能、肺灌注单光子发射计算机断层扫描和计算机断层扫描，对17例行CSS的患者、56例行单肺段切除的患者和41例行多肺段切除的患者的各保留肺叶的FEV1进行了检查。
CSS组的肿瘤大小明显小于多肺段切除组（1.4±0.5 vs. 2.0±0.8 cm，p = 0.002）。CSS组的肿瘤比多肺段切除组更频繁地位于右上叶（53% vs. 5%，p < 0.001）。CSS术后各肺叶的FEV1高于多肺段切除术后（0.3±0.2 vs. 0.2±0.2 l，p = 0.07）。CSS术后每个亚段各保留肺叶的平均FEV1明显高于多肺段切除术后（0.05±0.03 vs. 0.03±0.02 l，p = 0.02）。CSS组与单肺段切除组之间这些因素无显著差异。
CSS对于保留各肺叶的肺功能有效，特别是对于累及右上叶多个肺段且肺段比其他肺叶少的小肺癌。
