Kuriyama Shoji, Imai Kazuhiro, Saito Hajime, Takashima Shinogu, Kurihara Nobuyasu, Demura Ryo, Suzuki Haruka, Harata Yuzu, Sato Yusuke, Nakayama Katsutoshi, Nomura Kyoko, Minamiya Yoshihiro
Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan.
Interdiscip Cardiovasc Thorac Surg. 2023 May 4;36(5). doi: 10.1093/icvts/ivad035.
The division of inferior pulmonary ligament (IPL) during upper lobectomy (UL) was believed to be mandatory to dilate the remaining lung sufficiently. However, the benefits, especially postoperative pulmonary function, remain controversial. This study aimed to evaluate whether IPL division leads to pulmonary dysfunction.
This retrospective study included 213 patients who underwent UL between 2005 and 2018. They were categorized into an IPL division group (D group, n = 106) and a preservation group (P group, n = 107). Postoperative dead space at the lung apex, pulmonary function and complications were assessed using chest X-rays and spirometry. Changes in bronchial angle, cross-sectional area and circumference of the narrowed bronchus on the excised side were measured on three-dimensional computed tomography.
There was no significant difference in the postoperative complication rate, the dead space area, forced vital capacity (FVC), or forced expiratory volume in 1 s (FEV1) between the 2 groups after right UL (FVC; P = 0.838, FEV1; P = 0.693). By contrast, after left UL pulmonary function was significantly better in the P than in the D group (FVC; P = 0.038, FEV1; P = 0.027). Changes in bronchial angle did not significantly differ between the 2 groups. The narrowed bronchus's cross-sectional area (P = 0.021) and circumference (P = 0.009) were significantly smaller in the D group than in the P group after left UL.
IPL division during left UL caused postoperative pulmonary dysfunction and airflow limitation due to bronchial kinking. IPL preservation may have a beneficial impact on postoperative pulmonary function.
在上叶切除术（UL）中，人们认为切断下肺韧带（IPL）对于充分扩张余肺是必要的。然而，其益处，尤其是对术后肺功能的影响，仍存在争议。本研究旨在评估切断IPL是否会导致肺功能障碍。
这项回顾性研究纳入了2005年至2018年间接受UL的213例患者。他们被分为IPL切断组（D组，n = 106）和保留组（P组，n = 107）。使用胸部X线和肺功能仪评估肺尖的术后死腔、肺功能和并发症。在三维计算机断层扫描上测量切除侧狭窄支气管的支气管角度、横截面积和周长的变化。
右肺上叶切除术后两组之间的术后并发症发生率、死腔面积、用力肺活量（FVC）或1秒用力呼气量（FEV1）无显著差异（FVC；P = 0.838，FEV1；P = 0.693）。相比之下，左肺上叶切除术后，P组的肺功能明显优于D组（FVC；P = 0.038，FEV1；P = 0.027）。两组之间支气管角度的变化无显著差异。左肺上叶切除术后，D组狭窄支气管的横截面积（P = 0.021）和周长（P = 0.009）明显小于P组。
左肺上叶切除术中切断IPL会导致术后肺功能障碍和因支气管扭曲引起的气流受限。保留IPL可能对术后肺功能有有益影响。
