Sugiura Yasoo, Nakayama Takashi, Hashizume Toshinori
Department of General Thoracic Surgery, National Hospital Organization, Kanagawa National Hospital, Kanagawa Japan.
J Thorac Dis. 2020 Nov;12(11):6761-6768. doi: 10.21037/jtd-20-2370.
Postpneumonectomy syndrome (PPS) is a life-threatening condition characterized by the extrinsic compression of the mainstem bronchus after pneumonectomy, causing rapidly progressive dyspnea. Information regarding the predictive factors of this condition is limited. Thus, the current study aimed to identify the predictive findings that can help prepare the treatment of PPS in advance.
The present study is a retrospective observational study. We reviewed the medical records of 12 consecutive patients who underwent pneumonectomy for lung cancer or tuberculosis between 2009 and 2020. The anatomical findings evaluated via computed tomography scan, nutritional status assessed using laboratory data, respiratory function, intraoperative variables between PPS and non-postpneumonectomy-syndrome patients were compared.
There were two female patients who presented with left PPS (PPS 1 and PPS 2 aged 73 and 55 years, respectively). The median age of 10 non-postpneumonectomy-syndrome patients (n=6, men and n=4 women) was 66 (range, 54-76 years). Four and six patients underwent right and left pneumonectomy, respectively. The fat tissue thickness in the anterior mediastinum was significantly thinner in PPS than in non-postpneumonectomy-syndrome patients. However, the body mass index (BMI) and other nutritional parameters did not differ between PPS and non-postpneumonectomy-syndrome patients. The median vital capacity was higher in PPS than in non-postpneumonectomy-syndrome patients. The decrement of respiratory function and body weight after pneumonectomy did not differ between two groups. The intraoperative variables did not also differ between two groups.
The fat tissue in the anterior mediastinum between the bilateral lungs is an anchor that can help maintain the normal position of the mediastinum after pneumonectomy. Thus, the fat tissue thickness between the bilateral lungs can be a predictive factor for the occurrence of PPS before surgery.
肺切除术后综合征（PPS）是一种危及生命的疾病，其特征为肺切除术后主支气管受到外部压迫，导致迅速进展的呼吸困难。关于该疾病预测因素的信息有限。因此，本研究旨在确定有助于提前做好PPS治疗准备的预测性发现。
本研究为回顾性观察研究。我们回顾了2009年至2020年间连续12例因肺癌或肺结核接受肺切除术患者的病历。比较了通过计算机断层扫描评估的解剖学发现、使用实验室数据评估的营养状况、呼吸功能以及PPS患者与非肺切除术后综合征患者之间的术中变量。
有两名女性患者出现左PPS（PPS 1和PPS 2，年龄分别为73岁和55岁）。10例非肺切除术后综合征患者（6例男性，4例女性）的中位年龄为66岁（范围54 - 76岁）。分别有4例和6例患者接受了右肺和左肺切除术。PPS患者前纵隔脂肪组织厚度明显薄于非肺切除术后综合征患者。然而，PPS患者与非肺切除术后综合征患者之间的体重指数（BMI）和其他营养参数并无差异。PPS患者的中位肺活量高于非肺切除术后综合征患者。两组患者肺切除术后呼吸功能和体重的下降情况并无差异。两组患者的术中变量也无差异。
双侧肺之间前纵隔的脂肪组织是有助于维持肺切除术后纵隔正常位置的一个支撑结构。因此，双侧肺之间的脂肪组织厚度可作为术前PPS发生的预测因素。
