Homma Takahiro, Ojima Toshihiro, Yamamoto Yutaka, Shimada Yoshifumi, Akemoto Yushi, Kitamura Naoya, Yoshimura Naoki
Department of General Thoracic and Cardiovascular Surgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
Division of Thoracic Surgery, Joetsu General Hospital, Niigata, Japan.
J Thorac Dis. 2020 Aug;12(8):4224-4232. doi: 10.21037/jtd-20-886.
To assess the potential of the ultrasonographic sliding lung sign to detect severe intrathoracic adhesions before surgery.
This was a prospective, single-center, observational study including all patients aged 20-89 years undergoing elective thoracic surgery. Patients with pneumothorax, pyothorax, hemothorax, chylothorax, and hydrothorax were excluded. We recorded the ultrasound sliding lung sign, surgical characteristics, and follow-up parameters: past medical history, respiratory function, chest X-ray findings, and computed tomography (CT) findings. Severe intrathoracic adhesion was defined as the need for adhesiolysis requiring more than 30 minutes.
A total of 168 patients consented to participate. All 15 patients without the sliding lung sign had hard severe adhesions [specificity 100%, sensitivity 88.2%, positive predictive value (PPV) 100%, negative predictive value (NPV) 98.7%, and area under curve (AUC) 0.94]. There were two false-negative results, both of which were soft adhesions. Although blunting of the costophrenic (CP) angle, CT findings, past medical history, and restrictive lung disease were identified as significant risk factors of severe intrathoracic adhesion, all areas under the curve were low (0.71, 0.71, 0.69, 0.61, respectively). Thoracotomy frequency, intraoperative bleeding, operative time, and postoperative hospitalization were significantly greater in these patients than in those with non-severe adhesions.
The ultrasound sliding lung sign could be used to predict severe intrathoracic adhesions before surgery. Preoperative confirmation of the ultrasound sliding lung sign is important for planning surgical approaches and implementing appropriate safety management.
评估超声肺滑动征在术前检测严重胸内粘连的潜力。
这是一项前瞻性、单中心观察性研究，纳入所有年龄在20 - 89岁接受择期胸外科手术的患者。气胸、脓胸、血胸、乳糜胸和胸腔积液患者被排除。我们记录了超声肺滑动征、手术特征和随访参数：既往病史、呼吸功能、胸部X线检查结果和计算机断层扫描（CT）结果。严重胸内粘连定义为需要超过30分钟的粘连松解术。
共有168例患者同意参与。所有15例无肺滑动征的患者均有严重的硬性粘连[特异性100%，敏感性88.2%，阳性预测值（PPV）100%，阴性预测值（NPV）98.7%，曲线下面积（AUC）0.94]。有2例假阴性结果，均为软性粘连。虽然肋膈角（CP）变钝、CT检查结果、既往病史和限制性肺病被确定为严重胸内粘连的显著危险因素，但所有曲线下面积均较低（分别为0.71、0.71、0.69、0.61）。这些患者的开胸频率、术中出血、手术时间和术后住院时间均显著高于非严重粘连患者。
超声肺滑动征可用于术前预测严重胸内粘连。术前确认超声肺滑动征对于规划手术入路和实施适当的安全管理很重要。
