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左下肺叶切除术中肺叶间裂分割的血管内缝合技术

Intravascular Stapling Technique for Interlobar Fissure Division in the Left Lower Lobectomy.

作者信息

Tsunezuka Hiroaki, Nishimura Tomoki, Inoue Masayoshi

机构信息

Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Kyoto, Japan.

出版信息

Ann Thorac Cardiovasc Surg. 2019 Aug 20;25(4):219-221. doi: 10.5761/atcs.nm.18-00262. Epub 2019 Mar 11.

DOI:10.5761/atcs.nm.18-00262
PMID:30853693
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6698712/
Abstract

INTRODUCTION

Prolonged air leak is the most common complication after pulmonary resection. This occurs more frequently in patients with incomplete interlobar fissure, chronic obstructive pulmonary disease, or emphysema. Interlobar lymphadenopathy can make interlobar fissure division difficult.

SURGICAL TECHNIQUE

Several techniques of interlobar fissure division have been documented. The interlobar fissure is routinely divided using a stapler during pulmonary lobectomy. Normally, a stapler is used extravascularly. Here, we present a patient who successfully underwent interlobar fissure division wherein the jaw of the stapler passed through the interlobar pulmonary artery between A6 and A8 branches during resection of a lung squamous cell carcinoma in the left lower lobe with an interlobar lymphadenopathy.

CONCLUSION

Interlobar fissure division inserting a jaw of stapler into pulmonary artery is easy and useful option for left lower lobectomy. This technique is especially useful for a patient with an interlobar lymphadenopathy.

摘要

引言

持续性漏气是肺切除术后最常见的并发症。这种情况在肺叶间裂不完全、慢性阻塞性肺疾病或肺气肿患者中更频繁发生。肺叶间淋巴结肿大可使肺叶间裂的分离变得困难。

手术技术

已有多种肺叶间裂分离技术的记录。在肺叶切除术中，通常使用吻合器分离肺叶间裂。通常，吻合器在血管外使用。在此，我们报告一例患者，在切除左下叶肺鳞状细胞癌并伴有肺叶间淋巴结肿大的过程中，吻合器的钳头穿过A6和A8分支之间的肺叶间肺动脉，成功完成了肺叶间裂的分离。

结论

将吻合器钳头插入肺动脉进行肺叶间裂分离，对于左下叶切除术来说是一种简单且有用的方法。该技术对于伴有肺叶间淋巴结肿大的患者尤其有用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/10d0/6698712/13b8d986abca/atcs-25-219-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/10d0/6698712/a3b3dacb4144/atcs-25-219-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/10d0/6698712/13b8d986abca/atcs-25-219-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/10d0/6698712/a3b3dacb4144/atcs-25-219-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/10d0/6698712/13b8d986abca/atcs-25-219-g002.jpg

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本文引用的文献

1
Fissureless fissure-last video-assisted thoracoscopic lobectomy for all lung lobes: a better alternative to decrease the incidence of prolonged air leak?无肺裂及肺裂最后处理的全肺叶电视辅助胸腔镜肺叶切除术：降低持续性漏气发生率的更好选择？
Eur J Cardiothorac Surg. 2016 Jul;50(1):118-23. doi: 10.1093/ejcts/ezv455. Epub 2016 Jan 19.
2
Is bipolar thermofusion an acceptable option for unseparated interlobar fissure division in pulmonary lobectomy?双极热融合术对于肺叶切除术中未分离的叶间裂离断来说是一种可接受的选择吗？
Interact Cardiovasc Thorac Surg. 2013 Jul;17(1):26-31. doi: 10.1093/icvts/ivt113. Epub 2013 Apr 11.
3
Quantifying the incidence and impact of postoperative prolonged alveolar air leak after pulmonary resection.
量化肺切除术后肺泡持续漏气的发生率和影响。
J Thorac Cardiovasc Surg. 2013 Apr;145(4):948-954. doi: 10.1016/j.jtcvs.2012.08.044. Epub 2012 Sep 13.
4
A prospective randomized trial comparing stapler and laser techniques for interlobar fissure completion during pulmonary lobectomy.一项比较肺叶切除术中应用订书机和激光技术完成叶间裂的前瞻性随机试验。
Lasers Med Sci. 2013 Feb;28(2):505-11. doi: 10.1007/s10103-012-1097-0. Epub 2012 Apr 24.
5
The approach of fused fissures with fissureless technique decreases the incidence of persistent air leak after lobectomy.采用无裂隙技术融合裂隙可降低肺叶切除术后持续性漏气的发生率。
Eur J Cardiothorac Surg. 2007 Feb;31(2):203-8. doi: 10.1016/j.ejcts.2006.11.030. Epub 2006 Dec 18.