Johns Hopkins School of Medicine, Baltimore, Maryland.
Johns Hopkins School of Medicine, Baltimore, Maryland.
J Surg Res. 2024 Jul;299:137-144. doi: 10.1016/j.jss.2024.04.011. Epub 2024 May 15.
Pulmonary lobectomy can result in intercostal nerve injury, leading to denervation of the rectus abdominis (RA) resulting in asymmetric muscle atrophy or an abdominal bulge. While there is a high rate of intercostal nerve injury during thoracic surgery, there are no studies that evaluate the magnitude and predisposing factors for RA atrophy in a large cohort.
A retrospective chart review was conducted of 357 patients who underwent open, thoracoscopic or robotic pulmonary lobectomy at a single academic center. RA volumes were measured on computed tomography scans preoperatively and postoperatively on both the operated and nonoperated sides from the level of the xiphoid process to the thoracolumbar junction. RA volume change and association of surgical/demographic characteristics was assessed.
Median RA volume decreased bilaterally after operation, decreasing significantly more on the operated side (-19.5%) versus the nonoperated side (-6.6%) (P < 0.0001). 80.4% of the analyzed cohort experienced a 10% or greater decrease from preoperative RA volume on the operated side. Overweight individuals (body mass index 25.5-29.9) experienced a 1.7-fold greater volume loss on the operated side compared to normal weight individuals (body mass index 18.5-24.9) (P = 0.00016). In all right-sided lobectomies, lower lobe resection had the highest postoperative volume loss (Median (interquartile range): -28 (-35, -15)) (P = 0.082).
This study of postlobectomy RA asymmetry includes the largest cohort to date; previous literature only includes case reports. Lobectomy operations result in asymmetric RA atrophy and predisposing factors include demographics and surgical approach. Clinical and quality of life outcomes of RA atrophy, along with mitigation strategies, must be assessed.
肺叶切除术可导致肋间神经损伤，导致腹直肌（RA）去神经支配，导致非对称肌肉萎缩或腹部膨出。虽然在胸部手术中有很高的肋间神经损伤发生率，但没有研究评估大样本中 RA 萎缩的程度和易患因素。
对单中心 357 例接受开放、电视胸腔镜或机器人肺叶切除术的患者进行回顾性图表分析。术前和术后在剑突水平至胸腰椎交界处，在 CT 扫描上测量 RA 体积。评估 RA 体积变化和手术/人口统计学特征的相关性。
术后双侧 RA 体积中位数均减小，术后 RA 体积在手术侧显著减小（-19.5%），而非手术侧（-6.6%）（P<0.0001）。分析队列中 80.4%的患者在手术侧的 RA 体积比术前减少了 10%或更多。超重个体（BMI 25.5-29.9）与正常体重个体（BMI 18.5-24.9）相比，手术侧的体积损失增加了 1.7 倍（P=0.00016）。在所有右肺叶切除术患者中，下叶切除术后 RA 体积损失最大（中位数（四分位距）：-28（-35，-15））（P=0.082）。
本研究包括迄今为止最大的肺叶切除术后 RA 不对称性队列；以前的文献仅包括病例报告。肺叶切除术导致 RA 不对称性萎缩，易患因素包括人口统计学和手术方式。必须评估 RA 萎缩的临床和生活质量结果以及缓解策略。
