Tao Hiroyuki, Hayashi Masataro, Furukawa Masashi, Miyazaki Ryohei, Yokoyama Shintaro, Hara Akio, Okabe Kazunori
Department of Thoracic Surgery, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, 670-8540, Japan.
Division of Thoracic Surgery, Department of Surgery, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan.
Gen Thorac Cardiovasc Surg. 2019 Feb;67(2):234-238. doi: 10.1007/s11748-018-0997-8. Epub 2018 Aug 30.
We previously reported that the use of a stapler to divide intersegmental planes did not decrease preserved pulmonary volume or function relative to electrocautery. However, preservation of pulmonary volume or function can be compromised when a stapler is used with larger intersegmental planes. Here, we assessed the correlations between preserved lung volume and pulmonary function after segmentectomy and the size of the intersegmental planes, based on the division method.
Intersegmental plane sizes in 56 patients were semi-automatically calculated using image analysis software on computed tomography images. The ratios of the remnant segment and ipsilateral lung volumes to their preoperative values (R-seg and R-ips) and the ratio of the postoperative pulmonary function relative to the predicted value were calculated based on three-dimensional volumetry. Correlations between preserved lung volume and pulmonary function and the intersegmental plane sizes were analyzed according to the division method.
Intersegmental planes were divided by either electrocautery or with a stapler (EC/Mixed) in 21 patients and by stapler alone (ST) in 35 patients. There was no difference in the average size of the intersegmental planes between the two groups. The intersegmental plane size negatively correlated with R-seg in the ST group.
Using the stapler method, as the size of the intersegmental planes increased, the preserved remnant segmental volume decreased; however, relation between the plane size and preserved pulmonary function was unclear. These findings indicate that stapler use is acceptable even for large intersegmental planes.
我们之前报道过，相对于电灼法，使用吻合器分割节段间平面并不会减少保留的肺容积或功能。然而，当吻合器用于较大的节段间平面时，肺容积或功能的保留可能会受到影响。在此，我们基于分割方法评估了肺段切除术后保留的肺容积和肺功能与节段间平面大小之间的相关性。
使用计算机断层扫描图像上的图像分析软件半自动计算56例患者的节段间平面大小。根据三维容积测量法计算残余节段和同侧肺容积与其术前值的比值（R-seg和R-ips）以及术后肺功能相对于预测值的比值。根据分割方法分析保留的肺容积和肺功能与节段间平面大小之间的相关性。
21例患者采用电灼法或吻合器联合电灼法（EC/混合法）分割节段间平面，35例患者仅采用吻合器（ST）分割。两组节段间平面的平均大小无差异。ST组节段间平面大小与R-seg呈负相关。
使用吻合器法时，随着节段间平面大小的增加，保留的残余节段容积减小；然而，平面大小与保留的肺功能之间的关系尚不清楚。这些发现表明，即使对于较大的节段间平面，使用吻合器也是可以接受的。
