Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, Osaka, 573-1191, Japan.
J Cardiothorac Surg. 2023 Apr 11;18(1):132. doi: 10.1186/s13019-023-02220-6.
Postoperative cerebral infarction is a rare but serious complication after lung cancer surgery. We aimed to investigate the risk factors and evaluate the efficiency of our devised surgical procedure to prevent cerebral infarction.
We retrospectively examined 1,189 patients who underwent a single lobectomy for lung cancer at our institution. We identified the risk factors for cerebral infarction and investigated the preventive effects of performing resection of the pulmonary vein as the last step of the surgical procedure during left upper lobectomy.
Among the 1,189 patients, we identified 5 male patients (0.4%) with postoperative cerebral infarction. All five underwent left-sided lobectomy including three upper and two lower lobectomies. Left-sided lobectomy, a lower forced expiratory volume in 1 s, and lower body mass index were associated with postoperative cerebral infarction (Ps < 0.05). The 274 patients who underwent left upper lobectomy were stratified by two procedures: lobectomy with resection of the pulmonary vein as the last step of the surgical procedure (n = 120) and the standard procedure (n = 154). The former procedure significantly shortened the length of the pulmonary vein stump when compared with the standard procedure (mean stump length: 15.1 vs. 18.6 mm, P < 0.01), and the shorter pulmonary vein might possibly prevent postoperative cerebral infarction (frequency: 0.8% vs. 1.3%, Odds ratio: 0.19, P = 0.31).
Resecting the pulmonary vein as the last step during the left upper lobectomy enabled the length of the pulmonary stump to be significantly shorter, which may contribute to preventing cerebral infarction.
术后脑梗死是肺癌手术后一种罕见但严重的并发症。我们旨在研究其风险因素，并评估我们设计的手术程序预防脑梗死的效果。
我们回顾性检查了在我院行单肺叶切除术的 1189 例肺癌患者。我们确定了脑梗死的危险因素，并研究了在上肺叶切除术的最后一步切除肺静脉对预防脑梗死的效果。
在 1189 例患者中，我们发现 5 例（0.4%）术后发生脑梗死。这 5 例患者均行左侧肺叶切除术，包括 3 例左上肺叶切除术和 2 例左下肺叶切除术。左侧肺叶切除术、较低的 1 秒用力呼气容积和较低的体重指数与术后脑梗死相关（Ps<0.05）。274 例行左上肺叶切除术的患者按两种程序分层：肺静脉切除作为手术最后一步的肺叶切除术（n=120）和标准程序（n=154）。前者与标准程序相比，显著缩短了肺静脉残端的长度（残端长度：15.1 毫米 vs. 18.6 毫米，P<0.01），较短的肺静脉可能预防术后脑梗死（发生率：0.8% vs. 1.3%，优势比：0.19，P=0.31）。
在上肺叶切除术的最后一步切除肺静脉可显著缩短肺静脉残端的长度，可能有助于预防脑梗死。
