Seok Yangki, Cho Sukki, Lee Ja Young, Yang Hee Chul, Kim Kwhanmien, Jheon Sanghoon
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoungnam-si, South Korea.
Interact Cardiovasc Thorac Surg. 2014 Feb;18(2):183-8. doi: 10.1093/icvts/ivt463. Epub 2013 Nov 14.
Upper lobectomy inevitably leads to an upward displacement of the remaining lower lobe. Such displacement may result in bronchial angulation, thereby narrowing the airway. We hypothesized that the degree of displacement of the bronchus is associated with the degree of exacerbation of postoperative pulmonary dysfunction. This study investigated whether bronchial angulation affects postoperative pulmonary function.
Patients undergoing upper lobectomy for lung cancer were retrospectively evaluated. A check for the presence of dyspnoea, pulmonary function test, chest X-ray and chest computed tomography (CT) were performed at 3 and 12 months postoperatively in these patients. The angle formed by the main bronchus and the bronchus intermedius on the right side and that by the main bronchus and the lower lobar bronchus were measured using the coronal view of the chest CT. We analysed the relationship between the change in bronchial angle and pulmonary function.
Ninety-nine patients were enrolled in this study. Among these patients, 50 underwent left upper lobectomy (LUL) and 49 underwent right upper lobectomy (RUL). Nine patients who underwent LUL showed worsening symptoms, and among them, 8 presented an increase in the angle. However, among the 9 patients with worsening symptoms after RUL, only 4 presented an increase in the angle. Decreased forced expiratory volume in 1 s (FEV1) from 3 to 12 months after surgery was observed in 16 patients in the LUL group and 14 in the RUL group. Exacerbation of pulmonary dysfunction was associated with an increase in the bronchial angle (P = 0.04 for LUL and P = 0.02 for RUL). The degree of angle change was also associated with the extent of FEV1 reduction (P = 0.02 for LUL and P = 0.02 for RUL).
Although the change in the bronchial angle is a physiological condition, it can reduce postoperative pulmonary function. The measurement of the change in the angle using the coronal view of a chest CT is a useful screening tool for predicting the postoperative reduction in FEV1.
上叶切除术不可避免地会导致剩余下叶向上移位。这种移位可能导致支气管成角，从而使气道变窄。我们推测支气管移位程度与术后肺功能恶化程度相关。本研究调查了支气管成角是否会影响术后肺功能。
对因肺癌接受上叶切除术的患者进行回顾性评估。在这些患者术后3个月和12个月时进行呼吸困难检查、肺功能测试、胸部X线和胸部计算机断层扫描（CT）。使用胸部CT的冠状位视图测量右侧主支气管与中间支气管形成的角度以及左侧主支气管与下叶支气管形成的角度。我们分析了支气管角度变化与肺功能之间的关系。
本研究共纳入99例患者。其中，50例行左上叶切除术（LUL），49例行右上叶切除术（RUL）。9例接受LUL的患者症状恶化，其中8例角度增大。然而，在9例RUL后症状恶化的患者中，只有4例角度增大。LUL组16例患者和RUL组14例患者术后3至12个月观察到1秒用力呼气量（FEV1）下降。肺功能恶化与支气管角度增大相关（LUL组P = 0.04，RUL组P = 0.02）。角度变化程度也与FEV1降低程度相关（LUL组P = 0.02，RUL组P = 0.02）。
尽管支气管角度变化是一种生理状况，但它会降低术后肺功能。使用胸部CT冠状位视图测量角度变化是预测术后FEV1降低的有用筛查工具。
