Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Nagano, Japan.
Interact Cardiovasc Thorac Surg. 2022 Jun 1;34(6):1062-1070. doi: 10.1093/icvts/ivab356.
Following right upper lobectomy, the right middle lobe may shift towards the apex and rotate in a counterclockwise direction with respect to the hilum. This study aimed to investigate the incidence and clinical impact of middle lobe rotation in patients undergoing right upper lobectomy.
From January 2014 to November 2018, 82 patients underwent right upper lobectomy at our institution for lung cancer using a surgical stapler to divide the minor fissure. Postoperative computed tomography scans evaluated the counterclockwise rotation of the middle lobe, in which the staple lines placed on the minor fissure were in contact with the major fissure of the right lower lobe (120° counterclockwise rotation). Clinicoradiological factors were evaluated and compared between patients with and without middle lobe rotation. We also reviewed surgical videos in patients with middle lobe rotation to evaluate the position of the middle lobe at the end of surgery.
Nine patients had a middle lobe rotation (11%), where 1 patient required surgical derotation. Patients with middle lobe rotation were significantly associated with more frequent right middle lobe atelectasis and severe postoperative complications compared with those without rotation. A surgical video review detected potential middle lobe rotation at the end of the surgery.
Middle lobe rotation without torsion following right upper lobectomy is not rare, and it is associated with adverse postoperative courses. Careful positioning of the right middle lobe at the end of surgery is warranted to improve postoperative outcomes.
右上肺叶切除术后，右中叶可能向肺尖移位，并相对于肺门沿逆时针方向旋转。本研究旨在探讨在使用手术吻合器切断小裂的患者中，右中上肺叶切除术后中叶旋转的发生率和临床影响。
2014 年 1 月至 2018 年 11 月，我院 82 例肺癌患者采用手术吻合器行右上肺叶切除术，术中切断小裂。术后 CT 扫描评估中叶的逆时针旋转，小裂上放置的吻合线与右下肺的主裂接触（逆时针旋转 120°）。评估并比较有和无中叶旋转患者的临床影像学因素。我们还对有中叶旋转的患者的手术视频进行了回顾性分析，以评估手术结束时中叶的位置。
9 例患者发生中叶旋转（11%），其中 1 例需要手术复位。与无旋转组相比，有中叶旋转组的右中叶肺不张和严重术后并发症更为常见。手术视频回顾发现，在手术结束时可能存在中叶旋转。
右上肺叶切除术后无扭转的中叶旋转并不少见，且与术后不良转归相关。在手术结束时，需要仔细定位右中叶，以改善术后结果。
