裂隙 - 最后一个视频辅助胸腔镜下非上叶肺叶切除术

Fissure-last video-assisted thoracoscopic lobectomy for 'non-upper' lobes.

作者信息

Stamenovic Davor, Bostanci Korkut, Messerschmidt Antje, Tillmann Jahn, Kostic Marko, Schneider Thomas

机构信息

Department of Thoracic Surgery, St. Vincentius Kliniken, Karlsruhe, Germany.

Department of Thoracic Surgery, Faculty of Medicine, Marmara University, Istanbul, Turkey.

出版信息

ANZ J Surg. 2017 Dec;87(12):1021-1025. doi: 10.1111/ans.13884. Epub 2017 Jan 26.

DOI:10.1111/ans.13884

PMID:28124480

Abstract

BACKGROUND

Surgical approach into the fissural parenchyma may be an important and modifiable factor for the prevention of air leak after anatomical lung resections. Fissureless fissure-last technique has been described as useful technique to reduce air leak, yet in video-assisted thoracoscopic surgery (VATS) data are limited and mostly on the upper lobes. The purpose of this study is to evaluate the safety and feasibility of fissureless fissure-last VATS 'non-upper' lobectomies and the impact of it on the immediate outcome, especially relating to air leak.

METHODS

This study is a monocentric single-surgeon retrospective analysis on prospectively collected data. During 24 months, 46 patients underwent VATS 'non-upper' lobectomy or lower bilobectomy, with conventional (VATS-c) technique in 20 and fissureless fissure-last (VATS-f) technique in 26 patients. Results were evaluated according to preoperative, perioperative and postoperative parameters.

RESULTS

There were no differences between VATS-c and VATS-f groups in any characteristics or peri- and postoperative variables, except the number of staplers, where it was significantly higher in VATS-c group (MVATS-c = 5.7; MVATS-f = 7.7; P = 0.001). Operation time did not differ between the groups, but showed gender-related difference, being longer in males (MVATS-c = 188; MVATS-f = 157; P = 0.04). Prevalence of air leak was 20%; prolonged air leak (PAL) (>5 days) being 11% and PAL (>7 days) 0%. Patients with air leak were older by tendency (MVATS-c = 74.9; MVATS-f = 66.5; P = 0.08), had more complications (P = 0.025; relative risk = 2.65) and stayed longer at hospital (MVATS-c = 10.8; MVATS-f = 7.7; P = 0.02). Postoperative complications were present in 24% of patients.

CONCLUSION

VATS-f lobectomy is safe and feasible not only for 'upper' but also for 'non-upper' lobes. When applied to properly selected patients, it may reduce air leak and PAL and thus may potentially reduce the rate of complications.

摘要

背景

进入肺裂实质的手术方式可能是解剖性肺切除术后预防漏气的一个重要且可改变的因素。无肺裂、肺裂最后处理技术已被描述为一种减少漏气的有用技术，但在电视辅助胸腔镜手术（VATS）中，相关数据有限，且大多集中在上叶。本研究的目的是评估无肺裂、肺裂最后处理的VATS“非上叶”肺叶切除术的安全性和可行性及其对近期预后的影响，尤其是与漏气相关的影响。

方法

本研究是对前瞻性收集的数据进行的单中心单术者回顾性分析。在24个月期间，46例患者接受了VATS“非上叶”肺叶切除术或下叶双肺叶切除术，其中20例采用传统（VATS-c）技术，26例采用无肺裂、肺裂最后处理（VATS-f）技术。根据术前、围手术期和术后参数对结果进行评估。

结果

VATS-c组和VATS-f组在任何特征或围手术期及术后变量方面均无差异，但吻合器使用数量除外，VATS-c组显著更高（MVATS-c = 5.7；MVATS-f = 7.7；P = 0.001）。两组手术时间无差异，但存在性别相关差异，男性更长（MVATS-c = 188；MVATS-f = 157；P = 0.04）。漏气发生率为20%；持续性漏气（PAL）（>5天）为11%，PAL（>7天）为0%。有漏气的患者年龄有增大趋势（MVATS-c = 74.9；MVATS-f = 66.5；P = 0.08），并发症更多（P = 0.025；相对风险 = 2.65），住院时间更长（MVATS-c = 10.8；MVATS-f = 7.7；P = 0.02）。24%的患者出现术后并发症。