Ohtsuka Takashi, Goto Taichiro, Anraku Masaki, Kohno Mitsutomo, Izumi Yotaro, Horinouchi Hirohisa, Nomori Hiroaki
Department of Surgery, Section of General Thoracic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Tokyo 160-8582, Japan.
J Cardiothorac Surg. 2012 May 3;7:42. doi: 10.1186/1749-8090-7-42.
Anatomic sublobar resection is being assessed as a substitute to lobectomy for primary lung cancers. However, persistent air leak after anatomic sublobar resection is prevalent and increasing surgical morbidity and costs. The use of electrocautery is being popularized recently in anatomic sublobar resection. We have retrospectively evaluated the safety and efficacy of intersegmental plane dissection using electrocautery.
Between April 2009 to September 2010, 47 patients were treated with segmentectomy for clinical T1N0M0 non-small cell lung cancers. The intersegmental plane was dissected using electrocautery alone or in combination with staplers. We evaluated the methods of dividing intersegmental plane (electrocautery alone or combination with electrocautery and staplers), intraoperative blood loss, duration of chest tube placement, duration of surgery, preoperative FEV1.0%, incidence of prolonged air leak, length of postoperative hospital stay, postoperative pulmonary function at 6 months after surgery and the cost for sealing intersegmental plane.
Among the 47 patients, 22 patients underwent intersegmental plane dissection with electrocautery alone and 25 patients did in combination with electrocautery and staplers. The mean number of stapler cartridges used was only 1.3 in electrocautery and staplers group. Mean age, gender, number of patients whose FEV1% < 70% were similar between two groups. There was no statistical difference between electrocautery alone and combination with electrocautery and staplers group in duration of surgery (282 vs. 290 minutes), intraoperative blood loss (203 vs.151 ml), duration of chest tube placement (3.2 vs. 3.1 days), postoperative hospital stay (11.0 vs.10.0 days), postoperative loss of FEV1.0 (13 vs.8 %), loss of FVC (11 vs. 6 %) or incidence of minor postoperative complications [9 % (2/22) vs. 16 % (4/25), p = 0.30)]. However, incidence of prolonged air leak was higher in electrocautery alone group than in combination with electrocautery and staplers group [14 % (3/22) vs. 4 % (1/25), p = 0.025)]. The cost of materials for sealing air leaks amounted to €964 per patient in the electrocautery alone group and €1594 per patient in combination with electrocautery and staplers group.
The number of patients with prolonged air leak was higher in the electrocautery alone group. The use of staplers in addition to electrocautery may lead to reduced prolonged air leak. However, the use of electrocautery for intersegmental plane dissection appeared to be safe with acceptable postoperative complications and effective in reducing costs.
解剖性肺段切除术正被评估作为原发性肺癌肺叶切除术的替代方法。然而，解剖性肺段切除术后持续性漏气很常见，这增加了手术发病率和成本。电灼术最近在解剖性肺段切除术中得到了推广。我们回顾性评估了使用电灼术进行肺段间平面解剖的安全性和有效性。
2009年4月至2010年9月期间，47例临床T1N0M0非小细胞肺癌患者接受了肺段切除术。肺段间平面采用单纯电灼术或电灼术联合吻合器进行解剖。我们评估了划分肺段间平面的方法（单纯电灼术或电灼术与吻合器联合使用）、术中失血量、胸管留置时间、手术时间、术前第1秒用力呼气容积（FEV1.0%）、持续性漏气发生率、术后住院时间、术后6个月的肺功能以及封闭肺段间平面的成本。
47例患者中，22例患者采用单纯电灼术进行肺段间平面解剖，25例患者采用电灼术联合吻合器进行解剖。电灼术与吻合器联合使用组平均使用的吻合器钉仓数量仅为1.3个。两组患者的平均年龄、性别、FEV1%<70%的患者数量相似。单纯电灼术组与电灼术联合吻合器组在手术时间（282分钟对290分钟）、术中失血量（203毫升对151毫升）、胸管留置时间（3.2天对3.1天）、术后住院时间（11.0天对10.0天）、术后FEV1.0的下降（13%对8%）、用力肺活量（FVC）的下降（11%对6%）或术后轻微并发症发生率[9%（2/22）对16%（4/25），p = 0.30]方面无统计学差异。然而，单纯电灼术组的持续性漏气发生率高于电灼术联合吻合器组[14%（3/22）对4%（1/25），p = 0.025]。单纯电灼术组封闭漏气的材料成本为每位患者964欧元，电灼术联合吻合器组为每位患者1594欧元。
单纯电灼术组持续性漏气的患者数量较多。除电灼术外使用吻合器可能会减少持续性漏气。然而，使用电灼术进行肺段间平面解剖似乎是安全的，术后并发症可接受，并且在降低成本方面有效。
