Yamamoto Marino, Anayama Takashi, Okada Hironobu, Miyazaki Ryohei, Orihashi Kazumasa
Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kochi, Japan.
Department of Surgery II, Kochi Medical School, Kochi University, Kochi, Japan.
Quant Imaging Med Surg. 2021 Jul;11(7):3157-3164. doi: 10.21037/qims-20-1057.
Lobectomy, or the removal of a lobe of the lung, is the most commonly performed lung cancer surgery. One of the most severe postoperative complications is a bronchial stump fistula, which often occurs following a right lower lobectomy. During lymph node dissection, the bronchial arteries, which supply blood to the bronchus, are cut. Subsequently, reduced blood supply to the bronchus may result in bronchofistula. We investigated the relationship between the level of the surgical ligation of the bronchial arteries and the decrease in blood flow at the bronchial stump during a right lower lobectomy. This study aimed to clarify the relationship between the anatomical amputation level of the bronchial artery and the decrease in tissue oxygen saturation at the bronchial stump, allowing us to identify a surgical procedure that reduces the risk of a bronchopleural fistula following pulmonary lobectomy and an appropriate bronchial artery amputation site that could be used in future lobectomies.
We developed a new system (micro-tissue oxygen saturation) that enabled the semi-quantification of the oxygen saturation of thin tissues in pinpoint during video-assisted thoracic surgery. Changes in the blood flow at the bronchial stump were examined during lymph node dissection and bronchial artery amputation using a biological pig lobectomy model.
The regional oxygen saturation level at the bronchial wall was 95.5%±1.0% in normal conditions. A gradual decrease in regional oxygen saturation was observed, as the cutting point of the bronchial artery was moved higher. When the bronchial artery coursing into the middle lobe bronchus was preserved, the blood flow in the bronchus was preserved at 82.8%±1.3%. When the branches of the bronchial arteries running both inside and outside of the intermediate bronchial trunk were cut at high positions, regional oxygen saturation level decreased to 55.7%±1.2%.
The preservation of at least one bronchial artery at the level of the middle lobe bronchus minimizes the reduction of tissue oxygen saturation at the lower lobe bronchial stump. The ligation of bronchial arteries at a higher position results in desaturation <60%, which may increase the risk of bronchial stump fistula.
肺叶切除术，即切除肺的一个肺叶，是最常见的肺癌手术。最严重的术后并发症之一是支气管残端瘘，常发生在右下肺叶切除术后。在淋巴结清扫过程中，为支气管供血的支气管动脉会被切断。随后，支气管供血减少可能导致支气管瘘。我们研究了右下肺叶切除术中支气管动脉手术结扎水平与支气管残端血流减少之间的关系。本研究旨在阐明支气管动脉的解剖切断水平与支气管残端组织氧饱和度降低之间的关系，以便我们确定一种可降低肺叶切除术后支气管胸膜瘘风险的手术方法，以及一个可用于未来肺叶切除术的合适支气管动脉切断部位。
我们开发了一种新系统（微组织氧饱和度），能够在电视辅助胸腔手术期间对微小组织的氧饱和度进行半定量测定。使用生物猪肺叶切除模型，在淋巴结清扫和支气管动脉切断过程中检查支气管残端的血流变化。
正常情况下，支气管壁的局部氧饱和度水平为95.5%±1.0%。随着支气管动脉切断点位置升高，局部氧饱和度逐渐降低。当保留进入中叶支气管的支气管动脉时，支气管内的血流保持在82.8%±1.3%。当在高位切断走行于中间支气管主干内外的支气管动脉分支时，局部氧饱和度水平降至55.7%±1.2%。
在中叶支气管水平至少保留一支支气管动脉可最大程度减少下叶支气管残端组织氧饱和度的降低。在更高位置结扎支气管动脉会导致氧饱和度<60%，这可能增加支气管残端瘘的风险。
