Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
Transplantation Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Yonsei Med J. 2023 Dec;64(12):730-737. doi: 10.3349/ymj.2023.0104.
Clamshell incision offers excellent exposure and access to the pleural spaces and is a standard incision for lung transplantation. However, due to its high sternal complication rate, the clamshell incision is considered a procedure that requires improvement. In this study, we aimed to investigate the outcomes of transverse sternotomy with clamshell incision in comparison to sternum-sparing bilateral anterolateral thoracotomy (BAT).
In total, 134 bilateral sequential lung transplants were performed from May 2013 to June 2022. The clamshell incision was used between May 2013 and December 2017, and the BAT was introduced in January 2018. Thirty-four patients underwent clamshell surgery, and 100 patients underwent BAT. We retrospectively compared patient characteristics and perioperative and postoperative outcomes between the two groups.
The clamshell group required an operation time of 745.18±101.76 min, which was significantly longer than that of the BAT group at 669.90±134.09 min (=0.003). The mechanical ventilation period after surgery was 17.26±16.04 days in the clamshell group, significantly longer than the 11.35±12.42 days in the BAT group (=0.028). Intensive care unit stay was also significantly longer in the clamshell group (21.54±15.23 days vs. 15.03±14.28 days; =0.033). In-hospital mortality rates were 26.5% in the clamshell group and 22.0% in the BAT group.
Less-invasive lung transplantation via sternum-sparing BAT is a safe procedure with low morbidity and favorable outcomes. Preventing sternal instability enables more stable breathing after surgery, earlier weaning from mechanical ventilation, and faster recovery to routine activities.
蛤壳式切口提供了极好的显露和进入胸膜腔的通道，是肺移植的标准切口。然而，由于其胸骨并发症发生率高，蛤壳式切口被认为是一种需要改进的手术。在这项研究中，我们旨在比较横断胸骨加蛤壳式切口与保留胸骨双侧前外侧开胸术（BAT）在肺移植中的结果。
2013 年 5 月至 2022 年 6 月共进行了 134 例双侧序贯肺移植。蛤壳式切口于 2013 年 5 月至 2017 年 12 月使用，BAT 于 2018 年 1 月引入。34 例患者接受蛤壳式手术，100 例患者接受 BAT。我们回顾性比较了两组患者的一般特征、围手术期和术后结果。
蛤壳组的手术时间为 745.18±101.76 分钟，明显长于 BAT 组的 669.90±134.09 分钟（=0.003）。蛤壳组术后机械通气时间为 17.26±16.04 天，明显长于 BAT 组的 11.35±12.42 天（=0.028）。重症监护病房停留时间也明显长于蛤壳组（21.54±15.23 天 vs. 15.03±14.28 天；=0.033）。蛤壳组的院内死亡率为 26.5%，BAT 组为 22.0%。
通过保留胸骨的 BAT 进行微创肺移植是一种安全的手术，具有低发病率和良好的结果。防止胸骨不稳定可使术后呼吸更稳定，机械通气更快脱机，更快恢复到常规活动。
