Traibi Akram, Grigoroiu Madalina, Boulitrop Celia, Urena Anna, Masuet-Aumatell Cristina, Brian Emmanuel, Stern Jean-Baptiste, Zaimi Rym, Gossot Dominique
Thoracic Department, Institut Mutualiste Montsouris, Paris, France.
Interact Cardiovasc Thorac Surg. 2013 Nov;17(5):838-44. doi: 10.1093/icvts/ivt292. Epub 2013 Jul 17.
The role of anatomical pulmonary segmentectomy is increasing, but there are few data about its complication rate. We have analysed the postoperative morbidity, mortality and risk factors in a consecutive series of 228 segmentectomies performed in our department.
Between January 2007 and December 2011, 221 patients underwent 228 segmentectomies. There were 99 women (45%) and 122 men (55%). The mean age was 61 years (range 18-86 years). The mean forced expiratory volume in 1 s (FEV1) was 87%, and 30 patients had an FEV1 of ≤60%. Fifty-seven patients had a previous history of pulmonary resection. Indications for segmentectomy were: primary lung cancer (111 cases), metastases (71 cases), benign non-infectious (25 cases) and benign infectious diseases (21 cases). The approach was a posterolateral thoracotomy (Group PLT) in 146 patients (64%) and a thoracoscopy (Group TS) in 82 (36%). The two groups were homogenous in terms of age, gender, indications of surgery and type of segmentectomy.
The mortality rate at 3 months was 1.3% (3 patients). The overall complication rate was 34%. Ten patients were reoperated for the following reasons: haemothorax (4 cases), ischaemia of the remaining segment (3 cases), active bleeding (1 case), prolonged air leak (1 case) and dehiscence of thoracotomy (1 case). The average duration of drainage was 5 days (range 1-34 days) and the average length of stay was 9 days (range 3-126 days). On univariate analysis, FEV1, male gender and thoracotomy were statistically significant risk factors for complications. On multivariate analysis, the same three predictive factors of complications independently of age were found statistically significant: preoperative FEV1 < 60% [odds ratio (OR) = 5.9, 95% CI (2.5-13.7), P < 0.001] male gender [OR = 2.04, 95% CI (1.2-3.6), P < 0.013] and thoracotomy [OR = 2.14, 95% CI (1.33-3.46), P = 0.001].
Pulmonary anatomical segmentectomies have an acceptable morbidity rate. Postoperative complications are more likely to develop in male gender patients, with FEV1 ≤ 60% and operated by open surgery.
解剖性肺段切除术的作用日益增加，但关于其并发症发生率的数据较少。我们分析了在我科连续进行的228例段切除术患者的术后发病率、死亡率及危险因素。
2007年1月至2011年12月期间，221例患者接受了228例段切除术。其中女性99例（45%），男性122例（55%）。平均年龄为61岁（范围18 - 86岁）。一秒用力呼气容积（FEV1）平均为87%，30例患者FEV1≤60%。57例患者有肺切除史。段切除术的适应证为：原发性肺癌（111例）、转移瘤（71例）、良性非感染性疾病（25例）和良性感染性疾病（21例）。146例患者（64%）采用后外侧开胸手术（PLT组），82例患者（36%）采用胸腔镜手术（TS组）。两组在年龄、性别、手术适应证和段切除类型方面具有同质性。
3个月时死亡率为1.3%（3例患者）。总体并发症发生率为34%。10例患者因以下原因再次手术：血胸（4例）、余肺缺血（3例）、活动性出血（1例）、持续漏气（1例）和开胸切口裂开（1例）。平均引流时间为5天（范围1 - 34天），平均住院时间为9天（范围3 - 126天）。单因素分析显示，FEV1、男性性别和开胸手术是并发症的统计学显著危险因素。多因素分析发现，与年龄无关的相同三个并发症预测因素具有统计学显著性：术前FEV1<60%[比值比（OR）=5.9，95%可信区间（CI）（2.5 - 13.7），P<0.001]、男性性别[OR = 2.04，95%CI（1.2 - 3.6），P<0.013]和开胸手术[OR = 2.14，95%CI（1.33 - 3.46），P = 0.001]。
肺解剖性段切除术具有可接受的发病率。男性患者、FEV1≤60%且采用开放手术的患者术后更易发生并发症。
