Department of Thoracic Surgery, Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan.
Updates Surg. 2024 Oct;76(6):2313-2320. doi: 10.1007/s13304-024-01786-7. Epub 2024 Mar 25.
The right middle lobe often poorly expands after right upper lobectomy. Postoperative pulmonary function may be inferior after right upper lobectomy than after right lower lobectomy due to poor expansion of the middle lobe. This study examined the difference in the postoperative right middle lobe expansion and pulmonary function between right upper and right lower lobectomy. Patients who underwent right upper or right lower lobectomy through video-assisted thoracic surgery (n = 82) were enrolled in this retrospective study. Pulmonary function tests and computed tomography were performed preoperatively and at 1 year postoperatively. Using three-dimensional computed tomography volumetry, the preoperative and postoperative lung volumes were measured, and the predicted postoperative forced expiratory volume in 1 s was calculated. Middle lobe volume ratio (i.e., ratio of the postoperative to the preoperative middle lobe volume) and the postoperative forced expiratory volume in 1 s ratio (i.e., ratio of the measured to the predicted postoperative forced expiratory volume in 1 s) were compared between right upper and right lower lobectomy. Compared with the patients who underwent right upper lobectomy (n = 50), those who underwent right lower lobectomy (n = 32) had significantly higher middle lobe volume ratio (1.15 ± 0.32 vs. 1.63 ± 0.52, p < 0.001) and postoperative forced expiratory volume in 1 s ratio (1.12 ± 0.12 vs. 1.19 ± 0.13, p = 0.010). The right middle lobe showed more expansion and better recovery of postoperative pulmonary function after right lower lobectomy than after right upper lobectomy.
右肺中叶在右上肺叶切除术后常常扩张不良。由于中叶扩张不良，与右下肺叶切除术后相比，右上肺叶切除术后的术后肺功能可能较差。本研究旨在比较右上肺叶切除与右下肺叶切除术后右肺中叶扩张和肺功能的差异。
本回顾性研究纳入了 82 例行电视辅助胸腔镜手术的右上肺叶或右下肺叶切除术患者。所有患者分别于术前和术后 1 年进行了肺功能检查和 CT 检查。使用三维 CT 体层摄影术测量术前和术后的肺容积，并计算预测术后 1 秒用力呼气量。比较右上肺叶切除与右下肺叶切除患者的中叶体积比（即术后中叶体积与术前中叶体积的比值）和术后 1 秒用力呼气量比（即实测术后 1 秒用力呼气量与预测术后 1 秒用力呼气量的比值）。
与行右上肺叶切除术（n = 50）的患者相比，行右下肺叶切除术（n = 32）的患者中叶体积比明显更高（1.15 ± 0.32 比 1.63 ± 0.52，p < 0.001），术后 1 秒用力呼气量比也明显更高（1.12 ± 0.12 比 1.19 ± 0.13，p = 0.010）。与右上肺叶切除相比，右下肺叶切除后右肺中叶扩张程度更大，术后肺功能恢复更好。
