肺叶切除术后，近端结扎技术可防止肺静脉残端血栓形成。
Proximal ligation technique prevents thrombus formation in the pulmonary vein stump after lobectomy.
机构信息
Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan.
Department of Thoracic Surgery, Hachinohe City Hospital, 3-1-1 Tamukai, Hachinohe, Aomori, 031-0011, Japan.
出版信息
Surg Today. 2024 Aug;54(8):839-846. doi: 10.1007/s00595-024-02846-6. Epub 2024 May 3.
PURPOSE
To assess the risk factors for thrombosis in the pulmonary vein stump (PVT) and the efficacy of proximal ligation in preventing PVT after lobectomy.
METHODS
In total, 649 surgical patients with lung cancer were retrospectively reviewed. To compare the clinical effectiveness of PV proximal ligation, the simple stapler group (290 patients) and the proximal ligation group (359 patients who underwent thread ligation at the pericardial reflection with/without a stapler) were analyzed.
RESULTS
In the simple stapler group, 12 of 290 patients (4.1%) developed PVT. Among these, 9 of 58 underwent left upper lobectomy (LUL). In contrast, 5 of the 359 patients (1.4%) in the proximal ligation group developed PVT. All five patients received LUL. The incidence of PVT in the proximal ligation group was significantly lower than that in the simple stapler group (p = 0.0295) as well as in the analysis by LUL alone (p = 0.0263). A logistic regression analysis indicated that higher BMI and LUL were associated with the development of PVT (p = 0.0031, p < 0.0001), and PV proximal ligation reduced PVT (p = 0.0055).
CONCLUSION
Proximal ligation of the PV has the potential to prevent PVT, especially after LUL.
目的
评估肺静脉残端（PVT）血栓形成的危险因素，以及肺叶切除术后近端结扎预防 PVT 的效果。
方法
回顾性分析 649 例肺癌手术患者的临床资料。为了比较 PV 近端结扎的临床效果，分析了单纯吻合器组（290 例）和近端结扎组（359 例，在心包反折处采用线结扎联合/不联合吻合器）。
结果
在单纯吻合器组中，290 例患者中有 12 例（4.1%）发生 PVT，其中 9 例行左上肺叶切除术（LUL）。相比之下，近端结扎组的 359 例患者中有 5 例（1.4%）发生 PVT，所有患者均接受 LUL。近端结扎组的 PVT 发生率明显低于单纯吻合器组（p=0.0295）和单纯行 LUL 组（p=0.0263）。Logistic 回归分析表明，较高的 BMI 和 LUL 与 PVT 的发生相关（p=0.0031，p<0.0001），而 PV 近端结扎可降低 PVT 的发生（p=0.0055）。
结论
PV 近端结扎有可能预防 PVT，尤其是在 LUL 后。
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