Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
Eur J Cardiothorac Surg. 2011 Jul;40(1):e34-8. doi: 10.1016/j.ejcts.2011.02.021. Epub 2011 Mar 29.
Cutting the intersegmental plane by using a stapler during segmentectomy might interfere with the expansion of the preserved lung due to visceral pleura caught in a staple line, especially in a large regional segmentectomy, such as left upper division or basal segmentectomy. We compared the preserved lung volume after segmentectomy among the methods using stapler, sharp dissection, and their combination for cutting the intersegmental plane in ex vivo pig lungs. We also examined a covering effect of polyglycolic acid mesh and fibrin glue.
To assume a large regional segmentectomy in clinical practice, segments of the left caudal lobe except the lateral segment 2 (L2 segment) were resected, and the lung volume of the preserved L2 segment was measured. The intersegmental plane was cut by the following three methods: (1) stapler (n = 8); (2) scissors (n = 8); and (3) the combined method, that is, cutting the shallow lung tissue with scissors and the deep one with stapler (n = 8). The opened intersegmental plane was covered with polyglycolic acid mesh and fibrin glue. The air leakage was checked by injecting air through the bronchus at pressures of up to 30 cmH(2)O. Thereafter, normal saline was injected through the bronchus at pressures of 10, 20, and 30 cmH(2)O, to measure lung volumes by the volume-displacement method.
Polyglycolic acid mesh and fibrin glue prevented air leakage completely at up to 30 cmH(2)O. At the saline injection pressures of 10, 20, and 30 cmH(2)O, the mean volumes of L2 segment were 72 ± 14, 96 ± 14, and 109 ± 26 ml with the stapler; 86 ± 11, 117 ± 19, and 135 ± 39 ml with scissors; and 98 ± 10, 140 ± 20, and 155 ± 40 ml with the combined methods, respectively. The volume of the preserved L2 segment was significantly lower with the stapler method than with either the scissors or combined method at each pressure (p < 0.01). The difference was not significant between the scissors and combined methods.
Coverage with polyglycolic acid mesh and fibrin glue prevented air leakage from the opened intersegmental plane. The stapler interferes with the expansion of preserved lung in comparison to scissors or combined methods in a large regional segmentectomy.
在节段切除术中使用吻合器切割节间平面可能会因内脏胸膜夹在吻合线中而干扰保留肺的扩张，尤其是在较大的区域性节段切除术中，如左上叶或基底段切除术。我们比较了在离体猪肺中使用吻合器、锐性解剖和联合方法切割节间平面的节段切除术后保留肺体积。我们还检查了聚乙二醇酸网和纤维蛋白胶的覆盖效果。
为了模拟临床中的大区域节段切除术，切除除外侧段 2（L2 段）以外的左尾叶各段，测量保留的 L2 段的肺体积。节间平面通过以下三种方法切割：（1）吻合器（n = 8）；（2）剪刀（n = 8）；（3）联合方法，即使用剪刀切割浅层肺组织，使用吻合器切割深层肺组织（n = 8）。打开的节间平面用聚乙二醇酸网和纤维蛋白胶覆盖。通过支气管以高达 30cmH₂O 的压力注入空气以检查漏气情况。然后，通过支气管以 10、20 和 30cmH₂O 的压力注入生理盐水，通过体积置换法测量肺体积。
聚乙二醇酸网和纤维蛋白胶可完全防止高达 30cmH₂O 的空气泄漏。在生理盐水注射压力为 10、20 和 30cmH₂O 时，使用吻合器的 L2 段平均体积分别为 72 ± 14、96 ± 14 和 109 ± 26ml；使用剪刀的平均体积分别为 86 ± 11、117 ± 19 和 135 ± 39ml；使用联合方法的平均体积分别为 98 ± 10、140 ± 20 和 155 ± 40ml。在每个压力下，吻合器法的保留 L2 段体积明显低于剪刀或联合方法（p < 0.01）。剪刀法和联合法之间无显著差异。
聚乙二醇酸网和纤维蛋白胶覆盖可防止打开的节间平面漏气。与剪刀或联合方法相比，在较大的区域性节段切除术中，吻合器会干扰保留肺的扩张。
