通过膈神经冷冻消融术管理肺切除术后的胸腔：一项随机研究。

Management of Pleural Space After Lung Resection by Cryoneuroablation of Phrenic Nerve: A Randomized Study.

作者信息

Pan Xiao-Jie, Ou De-Bin, Lin Xing, Ye Ming-Fang

机构信息

1 Fujian Provincial Hospital, Fujian Medical University, Fuzhou, People's Republic of China.

出版信息

Surg Innov. 2017 Jun;24(3):240-244. doi: 10.1177/1553350616685201. Epub 2017 Jan 3.

DOI:10.1177/1553350616685201

PMID:28049376

Abstract

OBJECTIVES

Residual air space problems after pulmonary lobectomy are an important concern in thoracic surgical practice, and various procedures have been applied to manage them. This study describes a novel technique using controllable paralysis of the diaphragm by localized freezing of the phrenic nerve, and assesses the effectiveness of this procedure to reduce air space after pulmonary lobectomy.

METHODS

In this prospective randomized study, 207 patients who underwent lobectomy or bilobectomy and systematic mediastinal node dissection in our department between January 2009 and November 2013 were randomly allocated to a cryoneuroablation group or a conventional group. Patients in the cryoneuroablation group (n = 104) received phrenic nerve cryoneuroablation after lung procedures, and patients in the conventional group (n = 103) did not receive cryoneuroablation after the procedure. Data regarding preoperative clinical and surgical characteristics in both groups were collected. Both groups were compared with regard to postoperative parameters such as total amount of pleural drainage, duration of chest tube placement, length of hospital stay, requirement for repeat chest drain insertion, prolonged air leak, and residual space. Perioperative lung function was also compared in both groups. Recovery of diaphragmatic movement in the cryoneuroablation group was checked by fluoroscopy on the 15th, 30th, and 60th day after surgery.

RESULTS

There was no statistically significant difference in patient characteristics between the 2 groups; nor was there a difference in terms of hospital stay, new drain requirement, and incidence of empyema. In comparison with the conventional group, the cryoneuroablation group had less total drainage (1024 ± 562 vs 1520 ± 631 mL, P < .05), fewer cases of residual space (9 vs 2, P < .05), fewer cases of prolonged air leak (9 vs 1, P < .01), and shorter duration of drainage (3.2 ± 0.2 vs 4.3 + 0.3 days, P < .01). Diaphragmatic paralyses caused by cryoneuroablation reversed within 30 to 60 days.

CONCLUSIONS

Cryoneuroablation of the phrenic nerve offers a reasonable option for prevention of residual air space following major pulmonary resection.

摘要

目的

肺叶切除术后的残腔问题是胸外科手术实践中的一个重要关注点，并且已经应用了各种方法来处理这些问题。本研究描述了一种通过局部冷冻膈神经实现可控性膈肌麻痹的新技术，并评估该方法在减少肺叶切除术后残腔方面的有效性。

方法

在这项前瞻性随机研究中，2009年1月至2013年11月期间在我科接受肺叶切除术或双肺叶切除术及系统性纵隔淋巴结清扫术的207例患者被随机分配至冷冻神经消融组或传统组。冷冻神经消融组（n = 104）的患者在肺部手术后接受膈神经冷冻神经消融，传统组（n = 103）的患者在手术后未接受冷冻神经消融。收集两组患者术前的临床和手术特征数据。比较两组患者术后的参数，如胸腔引流量、胸管留置时间、住院时间、再次胸腔引流的需求、持续性漏气及残腔情况。同时比较两组患者围手术期的肺功能。通过术后第15天、30天和60天的透视检查冷冻神经消融组膈肌运动的恢复情况。

结果

两组患者的特征在统计学上无显著差异；住院时间、新的引流需求及脓胸发生率方面也无差异。与传统组相比，冷冻神经消融组的总引流量更少（1024 ± 562 vs 1520 ± 631 mL，P < .05），残腔病例更少（9例 vs 2例，P < .05），持续性漏气病例更少（9例 vs 1例，P < .01），引流持续时间更短（3.2 ± 0.2 vs 4.3 + 0.3天，P < .01）。冷冻神经消融导致的膈肌麻痹在30至60天内恢复。