Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.
Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Eur J Cardiothorac Surg. 2017 Dec 1;52(6):1197-1205. doi: 10.1093/ejcts/ezx174.
The video-assisted thoracic surgery (VATS) approach is encouraged over postero-lateral thoracotomy (PLT) for lobectomy in lung cancer. We compare the ribcage kinematics during exercise before and after both procedures, assuming that VATS, being minimally invasive, could better preserve ribcage expansion.
Thirty-one patients undergoing lobectomy by means of VATS (n = 20) or PLT (n = 11) were compared presurgery, after chest drainage removal (T1) and 2 months post-surgery (T2) during quiet breathing and incremental exercise. Spirometry, chest pain, ventilatory pattern and expansions of the ribcage (ΔVRC) and abdomen were measured. Furthermore, the expansion of the ribcage and abdomen in the operated (ΔVRC-OP and ΔVAB-OP, respectively) and non-operated (ΔVRC-NO and ΔVAB-NO, respectively) sides was also considered.
At T1, in both groups, spirometry worsened and chest pain increased, being higher after PLT. Tidal volume (VT) decreased after PLT because the ribcage expanded less due to reduced ΔVRC-OP. Contrary to this, in VATS, there were no changes in VT and ΔVRC, although ΔVRC-OP was lower, because ΔVRC-NO increased at high level of exercise. At T2, ΔVRC-OP was completely restored after VATS. At high levels of exercise following PLT, although patients still showed reduced ΔVRC and ΔVRC-OP, VT was restored owing to increased ΔVAB-NO.
We demonstrate VATS to have a reduced impact on ribcage kinematics while PLT induced restriction more markedly during exercise and still present 2 months after surgery. Patients adopt 2 different compensatory mechanisms, by shifting the expansion toward the contralateral ribcage after VATS and toward the abdomen after PLT. Our study justifies thoracoscopic lobectomy prompt recovery.
clinicaltrials.gov (NCT02910453).
与后外侧开胸术（PLT）相比，电视辅助胸腔镜手术（VATS）在肺癌肺叶切除术中更受推崇。我们比较了两种手术前后运动时的胸廓运动学，假设 VATS 作为一种微创方法可以更好地保持胸廓扩张。
31 例接受 VATS（n=20）或 PLT（n=11）肺叶切除术的患者在术前、拔除胸腔引流管后（T1）和术后 2 个月（T2）进行比较，在静息呼吸和递增运动期间测量肺活量、胸痛、通气模式以及胸廓（ΔVRC）和腹部的扩张。此外，还考虑了手术侧（ΔVRC-OP 和 ΔVAB-OP）和非手术侧（ΔVRC-NO 和 ΔVAB-NO）的胸廓和腹部扩张。
在 T1 时，两组患者的肺活量均恶化，胸痛增加，PLT 后胸痛更明显。由于 ΔVRC-OP 减少，PLT 后潮气量（VT）减少。相反，在 VATS 中，VT 和 ΔVRC 没有变化，尽管 ΔVRC-OP 较低，但由于在高运动水平下 ΔVRC-NO 增加。在 T2 时，VATS 后 ΔVRC-OP 完全恢复。在 PLT 后高运动水平下，尽管患者的 ΔVRC 和 ΔVRC-OP 仍有减少，但由于 ΔVAB-NO 的增加，VT 得到恢复。
我们证明 VATS 对胸廓运动学的影响较小，而 PLT 在运动时更明显地引起限制，并且在手术后 2 个月仍然存在。患者采用 2 种不同的代偿机制，在 VATS 后将扩张转移到对侧胸廓，在 PLT 后转移到腹部。我们的研究证明了胸腔镜肺叶切除术的快速恢复是合理的。
clinicaltrials.gov（NCT02910453）。
