Division of Chest Surgery, Hyogo Cancer Center, 13-70, Kitaoji-Cho, Akashi City, 673-8558, Japan.
Gen Thorac Cardiovasc Surg. 2024 Oct;72(10):674-683. doi: 10.1007/s11748-024-02019-9. Epub 2024 Mar 26.
Lobes occasionally displace after lobectomy, referred to as "lobar shifting". However, the benefits, especially in postoperative pulmonary function, remain controversial. This study aimed to measure the effect of lobar shifting on postoperative pulmonary function especially in the right upper lobe.
This retrospective study includes 273 right upper lobectomy patients (lobectomy group) and 24 right upper segmentectomy patients (segmentectomy group) from 2012 to 2021. The lobectomy group was further subdivided based on their Synapse Vincent image: with their postoperative middle lobe bronchus shifted toward the head (shift group: 176 cases) and without (non-shift group: 97 cases). Several factors were examined to determine the cause of lobar shifting. The rate of measured actual postoperative forced expiratory volume in 1 s (FEV1.0) to predicted postoperative FEV1.0 was analyzed and compared among the three groups.
Factors that correlated with lobar shifting included age (p < 0.001), a relatively small middle lobe volume (p = 0.03), no adhesions (p < 0.001), and good upper/middle and middle/lower lobulation (p = 0.04, p = 0.02). The rate of measured actual postoperative FEV1.0 to predicted postoperative FEV1 for the shift, non-shift, and segmentectomy groups were 112.5%, 107.9%, and 103.1% (shift vs non-shift: p = 0.04, shift vs segmentectomy: p = 0.02, non-shift vs segmentectomy: p = 0.19).
Lobar shifting after right upper lobectomy is influenced by morphological factors and may have a beneficial impact on postoperative pulmonary function.
肺叶切除术后，肺叶偶尔会发生移位，称为“肺叶移位”。然而，其对术后肺功能的益处，特别是对右上叶的影响，仍存在争议。本研究旨在测量肺叶移位对术后肺功能的影响，特别是对右肺上叶的影响。
本回顾性研究纳入了 2012 年至 2021 年期间 273 例接受右上肺叶切除术（肺叶切除术组）和 24 例接受右上肺段切除术（肺段切除术组）的患者。根据 Synapse Vincent 图像，肺叶切除术组进一步分为术后中叶支气管向头侧移位（移位组：176 例）和未移位（非移位组：97 例）。研究检查了多个因素，以确定肺叶移位的原因。分析并比较了三组中实测术后 1 秒用力呼气量（FEV1.0）与预测术后 FEV1.0 的比率。
与肺叶移位相关的因素包括年龄（p<0.001）、中叶体积相对较小（p=0.03）、无粘连（p<0.001）和上/中肺叶及中/下肺叶良好分叶（p=0.04，p=0.02）。移位组、非移位组和肺段切除术组实测术后 FEV1.0 与预测术后 FEV1 的比率分别为 112.5%、107.9%和 103.1%（移位组与非移位组：p=0.04，移位组与肺段切除术组：p=0.02，非移位组与肺段切除术组：p=0.19）。
右上肺叶切除术后肺叶移位受形态学因素影响，可能对术后肺功能有益。
