Zheng Bin, Xu Guobing, Fu Xiayu, Wu Weidong, Liang Mingqiang, Zeng Taidui, Zhang Shuliang, Zhu Yong, Zheng Wei, Chen Chun, Bédat Benoît, Swanson Scott J, Koike Terumoto, Iwata Hisashi, Bedetti Benedetta, Sato Masaaki
Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China.
Thoracic and Endocrine Unit, University Hospitals of Geneva, Geneva, Switzerland.
Transl Lung Cancer Res. 2019 Oct;8(5):658-666. doi: 10.21037/tlcr.2019.09.12.
The management of the intersegmental plane (ISP) is challenging during uniport video-assisted thoracoscopic (VATS) pulmonary segmentectomy. Staplers and electrocautery have been used extensively in ISP management. However, both of them have their respective drawbacks. Currently, we have provided a revised technique termed as "Combined Dimensional Reduction Method" (CDR method), for managing the ISP with combined application of ultrasonic scalpel and staplers. The study aimed to review the outcomes of patients who underwent uniport VATS segmentectomy with or without the CDR method in our institute and assess the feasibility and safety of the CDR method.
From March 2017 to February 2018, 220 patients who underwent uniport VATS segmentectomy were retrospectively reviewed. By using IQQA software, pulmonary structures were reconstructed as three-dimensional (3D) images, making the targeted structures could be identified preoperatively. For the management of the ISP, in the CDR group, we firstly used the ultrasonic scalpel to trim the 3D pulmonary structure along the intersegmental demarcation, making the remaining targeted parenchyma both sufficiently thin enough and located on a 2D plane; thus, enabling easy use of staplers in managing ISP. Whereas, in the non-CDR group, we only use the staplers to manage the ISPs. The clinical characteristics, complications, and postoperative pulmonary functions were compared between the two groups.
Propensity score analysis generated 2 well-matched pairs of 71 patients in CDR and non-CDR groups. There was no 30-day postoperative death or readmission in either group. The CDR group was significantly associated with the shorter operative time (178.3±35.8 209.2±28.7 min) (P=0.031) and postoperative stay (4.5±2.3 . 5.7±4.2 days) (P=0.041), compared to the non-CDR group. Moreover, no significant difference was observed in blood loss, a period of chest tube drainage, a period of ultrafine tube drainage, and postoperative pulmonary complications between the two groups. Moreover, the recovery rate of postoperative forced expiratory volume in 1 second (FEV1) or vital capacity (VC) at 1 and 3 months after segmentectomy was comparable between them.
The CDR method could make segmentectomy easier and more accurate, and therefore has the potential to be a viable and effective technique for uniport VATS pulmonary segmentectomy.
在单孔电视辅助胸腔镜（VATS）肺段切除术中，节段间平面（ISP）的处理具有挑战性。吻合器和电灼术已广泛应用于ISP的处理。然而，它们都有各自的缺点。目前，我们提出了一种改良技术，称为“联合降维法”（CDR法），用于联合应用超声刀和吻合器处理ISP。本研究旨在回顾我院采用或未采用CDR法行单孔VATS肺段切除术患者的治疗结果，并评估CDR法的可行性和安全性。
回顾性分析2017年3月至2018年2月期间220例行单孔VATS肺段切除术的患者。利用IQQA软件将肺部结构重建为三维（3D）图像，以便术前识别目标结构。对于ISP的处理，在CDR组中，我们首先使用超声刀沿节段间分界线修剪3D肺部结构，使剩余的目标实质既足够薄又位于二维平面上；从而便于使用吻合器处理ISP。而在非CDR组中，我们仅使用吻合器处理ISP。比较两组患者的临床特征、并发症及术后肺功能。
倾向评分分析在CDR组和非CDR组中生成了2对匹配良好的71例患者。两组术后30天均无死亡或再入院。与非CDR组相比，CDR组的手术时间（178.3±35.8对209.2±28.7分钟）（P=0.031）和术后住院时间（4.5±2.3对5.7±4.2天）（P=0.041）明显缩短。此外，两组在失血量、胸管引流时间、超细管引流时间和术后肺部并发症方面均未观察到显著差异。而且，两组在肺段切除术后1个月和3个月时的术后第1秒用力呼气量（FEV1）或肺活量（VC）的恢复率相当。
CDR法可使肺段切除术更简便、准确，因此有可能成为单孔VATS肺段切除术可行且有效的技术。
