Kawatani Natsuko, Yajima Toshiki, Shimizu Kimihiro, Nagashima Toshiteru, Ohtaki Yoichi, Obayashi Kai, Nakazawa Seshiru, Yazawa Tomohiro, Shirabe Ken
Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan.
Department of Innovative Cancer Immunotherapy, Graduate School of Medicine, Gunma University, Maebashi, Japan.
J Thorac Dis. 2023 Mar 31;15(3):1009-1017. doi: 10.21037/jtd-22-1212. Epub 2023 Feb 8.
Late-onset pulmonary fistula (LOPF) is a well-described complication after segmentectomy, but the precise incidence and risk factors are still unclear. We aimed to determine the incidence of, and risk factors for, LOPF development after segmentectomy.
A single-institution retrospective study was performed. A total of 396 patients who underwent segmentectomy were enrolled. Perioperative data were analyzed to identify the risk factors for LOPF requiring readmission according to univariate and multivariate analyses.
The overall morbidity rate was 19.4%. The incidence rates of prolonged air leak (PAL) in the early phase and LOPF in the late phase were 6.3% (25/396) and 4.5% (18/396), respectively. The most common surgical procedures with LOPF development were segmentectomy of the upper-division (n=6) and S (n=5). With a univariate analysis, presence of smoking-related diseases did not affect LOPF development (P=0.139). Conversely, segmentectomy with cranial side free space (CSFS) in the intersegmental plane and use of electrocautery to divide the intersegmental plane were associated with a high risk of LOPF development (P=0.006 and 0.009, respectively). A multivariate logistic regression analysis showed that segmentectomy with CSFS in the intersegmental plane and use of electrocautery were independent risk factors for LOPF development. Approximately 80% of patients who developed LOPF recovered by prompt drainage and pleurodesis without reoperation, whereas the remaining patients developed empyema due to delayed drainage.
Segmentectomy with CSFS is an independent risk factor for LOPF development. Careful postoperative follow up and rapid treatment are necessary to avoid empyema.
迟发性肺瘘（LOPF）是肺段切除术后一种常见的并发症，但确切的发病率和危险因素仍不清楚。我们旨在确定肺段切除术后LOPF的发病率及危险因素。
进行了一项单中心回顾性研究。共纳入396例行肺段切除术的患者。对围手术期数据进行分析，通过单因素和多因素分析确定需要再次入院治疗的LOPF的危险因素。
总体发病率为19.4%。早期持续性漏气（PAL）和晚期LOPF的发生率分别为6.3%（25/396）和4.5%（18/396）。发生LOPF最常见的手术方式是上叶肺段切除（n = 6）和S段切除（n = 5）。单因素分析显示，吸烟相关疾病的存在不影响LOPF的发生（P = 0.139）。相反，在段间平面有颅侧自由空间（CSFS）的肺段切除以及使用电灼法分离段间平面与LOPF发生的高风险相关（分别为P = 0.006和0.009）。多因素逻辑回归分析显示，在段间平面有CSFS的肺段切除和使用电灼法是LOPF发生的独立危险因素。约80%发生LOPF的患者通过及时引流和胸膜固定术得以康复，无需再次手术，而其余患者因引流延迟发展为脓胸。
在段间平面有CSFS的肺段切除是LOPF发生的独立危险因素。术后需仔细随访并进行快速治疗以避免脓胸。
