Kameyama Kenji, Ueshima Yasuo, Ikebe Satoshi, Nakazono Chiaki, Urata Youji, Okada Satoru, Inoue Masayoshi
Department of General Thoracic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi, Higashiyama-Ku, Kyoto, 605-0981, Japan.
Department of Pathology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.
Surg Today. 2023 Jan;53(1):31-41. doi: 10.1007/s00595-022-02618-0. Epub 2022 Nov 14.
Intraoperative control of air leaks is important for preventing prolonged air leaks after surgery. The usefulness of suturing free pericardial fat pads (FPFPs) as pledgets for repairing air leaks was investigated.
A total of 111 patients who underwent anatomical lung resection and required suture repair for intraoperative air leaks were retrospectively reviewed. Mattress sutures were performed using polyglycolic acid (PGA) sheets (PGA group; n = 60) in the early period (April 2014 to March 2018) and FPFPs (FPFP group; n = 51) in the late period (April 2018 to March 2021) as pledgets.
More patients had a history of smoking in the FPFP group than in the PGA group. The duration of air leakage was significantly shorter (mean 1.2 vs. 3.5 days, p = 0.002) and prolonged air leakage (> 5 days) was less frequently observed (23.3% vs. 5.9%, p = 0.016) in the FPFP group than in the PGA group. The FPFP group had fewer cases requiring pleurodesis and with recurrent air leaks than in the PGA group. In one case in the FPFP group, fat necrosis with fibrosis and fibrous adhesion to the visceral pleura was found on a pathological examination.
Parenchymal repair using FPFPs as pledgets can reduce prolonged air leaks after surgery.
术中控制漏气对于预防术后长期漏气很重要。本研究探讨了缝合游离心包脂肪垫（FPFP）作为修补漏气的棉垫的有效性。
回顾性分析了111例行解剖性肺切除且术中漏气需缝合修补的患者。在早期（2014年4月至2018年3月）使用聚乙醇酸（PGA）片进行褥式缝合（PGA组；n = 60），在后期（2018年4月至2021年3月）使用FPFP作为棉垫（FPFP组；n = 51）。
FPFP组吸烟史患者比PGA组更多。FPFP组漏气持续时间明显更短（平均1.2天对3.5天，p = 0.002），且与PGA组相比，较少观察到长期漏气（> 5天）（分别为23.3%对5.9%，p = 0.016）。与PGA组相比，FPFP组需要胸膜固定术和复发性漏气的病例更少。在FPFP组的1例病例中，病理检查发现脂肪坏死伴纤维化以及与脏层胸膜的纤维粘连。
使用FPFP作为棉垫进行实质修补可减少术后长期漏气。
