胸腔镜无裂叶切除术在致密肺裂患者中的疗效
The efficacy of thoracoscopic fissureless lobectomy in patients with dense fissures.
作者信息
Igai Hitoshi, Kamiyoshihara Mitsuhiro, Yoshikawa Ryohei, Osawa Fumi, Kawatani Natsuko, Ibe Takashi, Shimizu Kimihiro
机构信息
Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan.
Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan.
出版信息
J Thorac Dis. 2016 Dec;8(12):3691-3696. doi: 10.21037/jtd.2016.12.58.
BACKGROUND
Prolonged air leakage after a lobectomy remains a frequent complication in patients with dense fissures. To avoid postoperative air leakage, we used the "thoracoscopic fissureless technique" for patients with dense fissures. A thoracoscopic approach is useful for the fissureless technique because it gives a good operative view from various angles without dividing the fissure. In this study, we compared the peri- or intraoperative results of thoracoscopic fissureless lobectomies to traditional lobectomies with fissure dissection for pulmonary artery (PA) exposure in order to identify the efficacy of thoracoscopic fissureless lobectomy.
METHODS
Between April 2012 and November 2015, 175 patients underwent a thoracoscopic lobectomy with three or four ports, of whom 14 underwent a fissureless lobectomy because of dense fissures. We compared the characteristics and perioperative outcomes of the patients who underwent the fissureless technique (fissureless technique group, n=14) and the traditional fissure dissection technique for PA exposure (traditional technique group, n=161). In our department, fissureless lobectomy is indicated for patients with a fused fissure (fissural grade III or IV as proposed by Craig in 1997) or inflammation makes it difficult to expose the PA, while the traditional technique is used for other patients.
RESULTS
Although the fissureless technique group had longer operation time than the traditional technique group (P=0.0045), there was no significant inter-group difference about blood loss (P=0.85), occurrence rate of intraoperative massive bleeding (P=0.6) or conversion rate to thoracotomy (P=0.31). According to postoperative results, there was no significant inter-group difference in duration of chest tube drainage (P=0.56), length of postoperative hospital stay (P=0.14), or morbidity rate (P=0.16). No mortality occurred in either group.
CONCLUSIONS
A thoracoscopic fissureless lobectomy is feasible and safe, and useful to avoid postoperative air-leakage in patients with dense fissures.
背景
肺叶切除术后持续漏气仍是裂隙致密患者常见的并发症。为避免术后漏气，我们对裂隙致密的患者采用了“胸腔镜无裂隙技术”。胸腔镜手术方式对无裂隙技术很有用，因为它能从各个角度提供良好的手术视野，而无需分开裂隙。在本研究中，我们比较了胸腔镜无裂隙肺叶切除术与传统肺叶切除术（通过裂隙解剖暴露肺动脉）的围手术期或术中结果，以确定胸腔镜无裂隙肺叶切除术的疗效。
方法
2012年4月至2015年11月期间，175例患者接受了三孔或四孔胸腔镜肺叶切除术，其中14例因裂隙致密接受了无裂隙肺叶切除术。我们比较了接受无裂隙技术的患者（无裂隙技术组，n = 14）和采用传统裂隙解剖技术暴露肺动脉的患者（传统技术组，n = 161）的特征和围手术期结果。在我们科室，无裂隙肺叶切除术适用于裂隙融合的患者（如Craig在1997年提出的裂隙分级III或IV级）或炎症导致难以暴露肺动脉的患者，而传统技术用于其他患者。
结果
尽管无裂隙技术组的手术时间比传统技术组长（P = 0.0045），但两组间在出血量（P = 0.85）、术中大出血发生率（P = 0.6）或中转开胸率（P = 0.31）方面无显著差异。根据术后结果，两组间在胸管引流时间（P = 0.56）、术后住院时间（P = 0.14）或发病率（P = 0.16）方面无显著差异。两组均未发生死亡。
结论
胸腔镜无裂隙肺叶切除术可行且安全，有助于避免裂隙致密患者术后漏气。
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