Taguchi Shima, Saeki Noboru, Morio Atsushi, Nakamura Ryuji, Kamiya Satoshi, Ikeda Tsuyoshi, Oshita Kyoko, Hamada Hiroshi, Miyata Yoshihiro, Okada Morihito, Tsutsumi Yasuo M
Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan.
Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
Wideochir Inne Tech Maloinwazyjne. 2021 Mar;16(1):169-174. doi: 10.5114/wiitm.2020.95919. Epub 2020 Jun 1.
For successful pulmonary segmentectomy, the identification of boundaries between segments is important. Previous measures include tracing the intersegmental vessels by staining with a dye via the affected pulmonary artery or bronchus and inflating with oxygen via a high frequency ventilator. However, problems with these methods have been reported.
We developed a novel method using a manual jet ventilator (MJV) and investigated its efficacy in identification of the pulmonary intersegmental plane.
Patients underwent MJV for pulmonary segmentectomy in the period from January 2013 to December 2017 at our institution. The patients' characteristics, resected segments, availability of clear resection planes, and complications associated with MJV from medical records were investigated. A questionnaire survey was conducted with the surgeons on the effectiveness of lung segment identification using MJV.
Of 199 cases of planned pulmonary segmentectomy, 171 cases with descriptions of identified intersegmental planes were analyzed. Of these, 152 (89%) cases showed a clear boundary. There were 19 cases where the exact boundaries were not clearly identified, but segmentectomy was still performed. Furthermore, we found that identification of the right upper lobes was difficult (p = 0.0028). A subjective questionnaire was answered by the 12 surgeons who performed the procedures. All 12 responded that MJV was very effective or effective regarding clarity, safety, shorter identification time, and shorter resection time.
MJV enabled surgeons to more easily and safely identify the pulmonary intersegmental plane, thereby suggesting that MJV has clinical significance during pulmonary segmentectomy.
为成功实施肺段切除术，明确肺段之间的界限很重要。以往的方法包括通过经患侧肺动脉或支气管注入染料来追踪段间血管，以及通过高频通气机用氧气充气。然而，这些方法的问题已被报道。
我们开发了一种使用手动喷射通气机（MJV）的新方法，并研究其在识别肺段间平面方面的有效性。
2013年1月至2017年12月期间，在我院接受肺段切除术的患者接受了MJV。从病历中调查患者的特征、切除的肺段、清晰切除平面的可用性以及与MJV相关的并发症。就使用MJV进行肺段识别的有效性对外科医生进行了问卷调查。
在199例计划进行的肺段切除术中，分析了171例有段间平面识别描述的病例。其中，152例（89%）显示出清晰的界限。有19例未明确识别出确切界限，但仍进行了肺段切除术。此外，我们发现右上叶的识别困难（p = 0.0028）。12名实施手术的外科医生回答了一份主观问卷。所有12人都表示，MJV在清晰度、安全性、缩短识别时间和缩短切除时间方面非常有效或有效。
MJV使外科医生能够更轻松、安全地识别肺段间平面，从而表明MJV在肺段切除术中具有临床意义。
