Mimura Takeshi, Ishida Masayuki, Tadokoro Kazuki, Kamigaichi Atsushi, Hirai Yuya, Nishina Mai, Kagimoto Atsushi, Tsubokawa Norifumi, Yamashita Yoshinori
Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan, Kure, Hiroshima, Japan.
JTCVS Tech. 2024 Feb 13;24:186-196. doi: 10.1016/j.xjtc.2024.02.002. eCollection 2024 Apr.
For lung segmentectomy of small lung cancers, we used a microwave surgical instrument for lung parenchymal dissection mainly at the pulmonary hilum, which is difficult to handle with surgical staplers. This technique facilitated the insertion of staples.
In total, 116 patients with cStage 0-1A3 non-small cell lung cancer who underwent lung segmentectomy were included in this study. We compared the perioperative factors of the group in which a microwave surgical instrument was used for dissection procedures, including lung parenchymal dissection at the pulmonary hilum, and peripheral intersegmental dissection was performed with surgical staplers (group M+S: N = 69), with those of the group in which parenchymal dissection was performed mainly with surgical staplers without using the microwave surgical instrument (group S: N = 47).
Although more complex segmentectomies were performed in the M+S group ( = .001), the number of staple cartridges (7 staple cartridges vs 8 staple cartridges, = .005), the surgical times (179 vs 221 minutes, < .0001), and the blood loss (5 mL vs 30 mL, = .012) were significantly lower in the M+S group. The duration of chest tube placement was significantly shorter in the M+S group ( = .019), and postoperative complications of grade 2 or greater were significantly lower in the M+S group ( = .049).
The effective use of the microwave surgical instrument combined with surgical staplers can simplify pulmonary hilar and intersegmental plane dissections not only for simple segmentectomy but also for complex segmentectomy, leading to favorable intraoperative and postoperative outcomes.
对于小肺癌的肺段切除术，我们使用微波手术器械主要在肺门处进行肺实质解剖，而肺门处使用手术吻合器难以操作。该技术便于吻合器的插入。
本研究纳入了116例行肺段切除术的cStage 0 - 1A3期非小细胞肺癌患者。我们比较了使用微波手术器械进行解剖操作（包括在肺门处进行肺实质解剖，外周段间解剖使用手术吻合器）的组（M + S组：N = 69）与主要使用手术吻合器而不使用微波手术器械进行实质解剖的组（S组：N = 47）的围手术期因素。
尽管M + S组进行了更复杂的肺段切除术（P = 0.001），但M + S组的吻合器钉仓数量（7个吻合器钉仓对8个吻合器钉仓，P = 0.005）、手术时间（179分钟对221分钟，P < 0.0001）和失血量（5毫升对30毫升，P = 0.012）显著更低。M + S组胸管放置时间显著更短（P = 0.019），且M + S组2级及以上术后并发症显著更低（P = 0.049）。
微波手术器械与手术吻合器的有效结合不仅可简化肺门和段间平面解剖，不仅适用于简单肺段切除术，也适用于复杂肺段切除术，从而带来良好的术中和术后结果。
