Yano Motoki, Iwata Hisashi, Hashizume Masahiro, Shigemitsu Kikuo, Adachi Katsutoshi, Tokui Toshiya, Matsuyama Takaaki
Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
Ann Thorac Cardiovasc Surg. 2014;20(5):370-7. doi: 10.5761/atcs.oa.13-00161. Epub 2013 Nov 8.
The use of staplers for thoracic surgery has been regarded as a safe procedure though sometimes adverse events (AEs) of stapling are experienced. The aim of this study is to analyze AEs of lung tissue stapling.
A retrospective multi-institutional review was conducted by 27 institutions of the Central Japan Lung Cancer Surgery Study Group. During the research period, lung tissue stapling was performed 10908 times.
Total number of AEs related to stapling was 81 (0.74%). Seventy events occurred intraoperatively and 11 events occurred postoperatively. Intraoperative stapling AEs were air leakage (n = 26), laceration of the adjacent lung tissue (n = 23), stapling failure (n = 14), oozing (n = 4), and others (n = 3). The postoperative AEs were prolonged air leakage (n = 9), bleeding from the chest wall (n = 1), and postoperative bleeding (n = 1). Only one case died of acute exacerbation of interstitial pneumonia which was induced after completion lobectomy to cure postoperative bleeding. No relationship was seen between the incidence of AE and cartridge colors or compression types of staplers except the length of cartridges.
Lung tissue stapling in thoracic surgery was safe. The most frequent cause of AEs was stapler-tissue thickness mismatch. The appropriate selection of the cartridge color may decrease the AE incidence of the lung tissue stapling.
尽管有时会出现吻合器吻合的不良事件（AE），但吻合器在胸外科手术中的应用一直被认为是一种安全的操作。本研究的目的是分析肺组织吻合的不良事件。
日本中部肺癌手术研究组的27个机构进行了一项回顾性多机构研究。在研究期间，肺组织吻合共进行了10908次。
与吻合相关的不良事件总数为81例（0.74%）。术中发生70例，术后发生11例。术中吻合不良事件包括漏气（n = 26）、邻近肺组织撕裂（n = 23）、吻合失败（n = 14）、渗血（n = 4）和其他（n = 3）。术后不良事件包括持续性漏气（n = 9）、胸壁出血（n = 1）和术后出血（n = 1）。仅1例因术后出血行肺叶切除术后诱发间质性肺炎急性加重死亡。除吻合器钉仓长度外，不良事件发生率与吻合器钉仓颜色或压迫类型之间未见相关性。
胸外科手术中肺组织吻合是安全的。不良事件最常见的原因是吻合器与组织厚度不匹配。正确选择钉仓颜色可能会降低肺组织吻合的不良事件发生率。
