Tao Hiroyuki, Tanaka Toshiki, Hayashi Tatsuro, Yoshida Kumiko, Furukawa Masashi, Yoshiyama Koichi, Okabe Kazunori
Division of Thoracic Surgery, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan
Division of Thoracic Surgery, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan.
Interact Cardiovasc Thorac Surg. 2016 Oct;23(4):548-52. doi: 10.1093/icvts/ivw188. Epub 2016 Jun 19.
Dividing the intersegmental planes with a stapler during pulmonary segmentectomy leads to volume loss in the remnant segment. The aim of this study was to assess the influence of segment division methods on preserved lung volume and pulmonary function after segmentectomy.
Using image analysis software on computed tomography (CT) images of 41 patients, the ratio of remnant segment and ipsilateral lung volume to their preoperative values (R-seg and R-ips) was calculated. The ratio of postoperative actual forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) per those predicted values based on three-dimensional volumetry (R-FEV1 and R-FVC) was also calculated. Differences in actual/predicted ratios of lung volume and pulmonary function for each of the division methods were analysed. We also investigated the correlations of the actual/predicted ratio of remnant lung volume with that of postoperative pulmonary function.
The intersegmental planes were divided by either electrocautery or with a stapler in 22 patients and with a stapler alone in 19 patients. Mean values of R-seg and R-ips were 82.7 (37.9-140.2) and 104.9 (77.5-129.2)%, respectively. The mean values of R-FEV1 and R-FVC were 103.9 (83.7-135.1) and 103.4 (82.2-125.1)%, respectively. There were no correlations between the actual/predicted ratio of remnant lung volume and pulmonary function based on the division method. Both R-FEV1 and R-FVC were correlated not with R-seg, but with R-ips.
Stapling does not lead to less preserved volume or function than electrocautery in the division of the intersegmental planes.
在肺段切除术中使用吻合器分割节段间平面会导致残留节段体积减小。本研究的目的是评估节段分割方法对肺段切除术后保留肺体积和肺功能的影响。
使用图像分析软件对41例患者的计算机断层扫描（CT）图像进行分析，计算残留节段和同侧肺体积与术前值的比值（R-seg和R-ips）。还计算了术后1秒用力呼气量（FEV1）和用力肺活量（FVC）与基于三维容积测量法预测值的比值（R-FEV1和R-FVC）。分析了每种分割方法的肺体积和肺功能实际/预测比值的差异。我们还研究了残留肺体积实际/预测比值与术后肺功能实际/预测比值之间的相关性。
22例患者采用电灼或吻合器分割节段间平面，19例患者仅采用吻合器分割。R-seg和R-ips的平均值分别为82.7（37.9-140.2）%和104.9（77.5-129.2）%。R-FEV1和R-FVC的平均值分别为103.9（83.7-135.1）%和103.4（82.2-125.1）%。基于分割方法，残留肺体积的实际/预测比值与肺功能之间无相关性。R-FEV1和R-FVC均与R-seg无关，而与R-ips相关。
在节段间平面分割中，吻合器分割与电灼相比，不会导致保留的体积或功能减少。
