Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China.
Thorac Cancer. 2022 Feb;13(3):423-429. doi: 10.1111/1759-7714.14275. Epub 2021 Dec 14.
Clinically, some specific pulmonary nodules have safe resection margins that are located in multiple subsegments in the center of lung lobe. It is therefore difficult to ensure the resection margins through conventional combined subsegmentectomy or wedge resection, and thus lobectomy is required. For these types of pulmonary nodules, "split" operation was performed to fully inflate the reserved lung tissues on both sides. This study aimed to preliminarily assess the feasibility and safety of "split" operation.
Cases with these types of pulmonary nodules were selected. Some of the cases were subjected to "split" operation and the operation conditions, including operation time, bleeding amount, length of hospital stay, computed tomography (CT) reexaminations, and pulmonary function, were analyzed.
The "split" operation was performed and successfully completed for seven patients. There was no case of conversion to thoracotomy and the median operation time, bleeding amount, and length of hospital stay were 219 min, 30.0 ml, and 4 days, respectively. No death or pulmonary complications such as pulmonary infection, lung torsion, and bronchopleural fistula occurred, and only one patient had incision fat liquefaction. After 3 months, the median percentage of preserved pulmonary function was 85.8% and a CT scan showed that the reserved lung tissues of the seven patients were well inflated and without obvious imaging findings of atelectasis.
"Split" combined subsegmentectomy can be used as a new and safe operative method for deep pulmonary nodules with safe resection margins involving multiple subsegments in the center of the lung lobe.
临床上，某些特定的肺结节具有位于肺叶中心多个亚段内的安全切缘，因此很难通过常规的联合亚段切除术或楔形切除术来保证切缘，而需要进行肺叶切除术。对于这些类型的肺结节，采用“分割”手术使两侧保留的肺组织充分膨胀。本研究旨在初步评估“分割”手术的可行性和安全性。
选择此类肺结节患者，其中部分患者接受了“分割”手术，并分析了手术情况，包括手术时间、出血量、住院时间、计算机断层扫描（CT）复查和肺功能。
对 7 例患者成功实施了“分割”手术，无一例中转开胸。手术时间、出血量和住院时间的中位数分别为 219 分钟、30.0 毫升和 4 天。无死亡或肺部并发症，如肺部感染、肺扭转和支气管胸膜瘘，仅 1 例患者出现切口脂肪液化。术后 3 个月，保留肺功能的中位数百分比为 85.8%，CT 扫描显示 7 例患者的保留肺组织膨胀良好，无明显的肺不张影像学表现。
“分割”联合亚段切除术可作为一种新的安全手术方法，用于具有安全切缘的肺叶中心多亚段深部肺结节。
