Nguyen Aude, Solovei Laurence, Marty-Ané Charles, Bourdin Arnaud, Canaud Ludovic, Alric Pierre, Hireche Kheira
Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, 191 Avenue Doyen Gaston Giraud, 34090 Montpellier, France.
PhyMedExp, University of Montpellier, INSERM, CNRS, 34295 Montpellier, France.
Cancers (Basel). 2023 Oct 13;15(20):4971. doi: 10.3390/cancers15204971.
The aim of this single-center retrospective cohort study was to assess the impact of arterial reconstruction technique on lung perfusion. The second objective was to ascertain the functional validity of arterial sleeve lobectomy.
Between January 2001 and December 2020, a total of 81 patients underwent lobectomy with pulmonary artery (PA) reconstruction for lung cancer at the University Hospital of Montpellier. After excluding patients with an incomplete postoperative pulmonary function test, we conducted a comparative analysis of the preoperative and postoperative functional outcomes (FEV) of 48 patients, as well as the preoperative and postoperative Technetium99m scintigraphic pulmonary perfusion results of 28 patients. Then, we analyzed postoperative perfusion results according to the pulmonary artery reconstruction techniques use.
PA reconstruction types were as follows: 9 direct angioplasties (19%), 14 patch angioplasties (29%), 7 end-to-end anastomoses (15%), 6 prosthetic bypasses (12%), 11 arterial allograft bypasses (23%), and 1 custom-made xenopericardial conduit bypass. Regardless of the type of vascular reconstruction performed, the comparative analysis of lung perfusion revealed no significant difference between the preoperative and postoperative perfusion ratio of the remaining parenchyma (median = 29.5% versus 32.5%, respectively; = 0.47). Regarding the pulmonary functional test, postoperative predicted FEV significantly underestimated the actual postoperative measured FEV by about 260 mL (11.4%) of the preoperative value. The patency rate was 96% and the 5-year overall survival was 49% for a mean follow up period of 34 months.
Lobectomy with PA reconstruction is a valid parenchymal-sparing technique in terms of perfusion and respiratory function.
本单中心回顾性队列研究的目的是评估动脉重建技术对肺灌注的影响。第二个目的是确定动脉袖状肺叶切除术的功能有效性。
2001年1月至2020年12月期间，共有81例患者在蒙彼利埃大学医院接受了肺癌肺叶切除术并进行肺动脉（PA）重建。在排除术后肺功能测试不完整的患者后，我们对48例患者的术前和术后功能结局（FEV）以及28例患者的术前和术后锝99m闪烁显像肺灌注结果进行了比较分析。然后，我们根据所使用的肺动脉重建技术分析了术后灌注结果。
PA重建类型如下：9例直接血管成形术（19%），14例补片血管成形术（29%），7例端端吻合术（15%），6例人工血管旁路术（12%），11例动脉同种异体移植旁路术（23%），以及1例定制的异种心包管道旁路术。无论进行何种血管重建类型，肺灌注的比较分析显示，剩余实质的术前和术后灌注率之间无显著差异（中位数分别为29.5%和32.5%；P = 0.47）。关于肺功能测试，术后预测的FEV显著低估了术后实际测量的FEV，比术前值低约260 mL（11.4%）。通畅率为96%，平均随访34个月，5年总生存率为49%。
就灌注和呼吸功能而言，PA重建的肺叶切除术是一种有效的保留实质技术。
