Han Dong Jae, Ok You Jung, Oh Se Jin, Choi Jae-Sung, Seong Yong Won, Moon Hyeon Jong
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
J Chest Surg. 2024 Sep 5;57(5):477-483. doi: 10.5090/jcs.24.026. Epub 2024 Aug 8.
Torsion of the right middle lobe following right upper lobectomy is a rare but potentially fatal complication. To prevent this, fixation of the right middle lobe has been suggested. This study was performed to examine the impact of right middle lobe fixation on postoperative outcomes and bronchial changes.
We enrolled patients who underwent curative-intent video-assisted thoracic surgery (VATS) right upper lobectomy for lung cancer from 2019 to 2022. Participants were grouped based on whether they did or did not receive right middle lobe fixation. Bronchial angles were measured using preoperative and postoperative chest computed tomography images, and postoperative outcomes and bronchial changes were compared between the 2 groups.
The study included a total of 50 patients, with 17 (34%) undergoing right middle lobe fixation. All procedures were performed using VATS. No significant differences between groups were observed in preoperative characteristics or postoperative outcomes. After surgery, both groups exhibited a significant increase in the right bronchus intermedius angle and a significant decrease in the branch angle. The postoperative right bronchus intermedius angle was significantly larger in the group without right middle lobe fixation compared to the group with fixation (47.38°±10.98° vs. 39.41°±9.21°, p=0.014). Three cases of atelectasis occurred in the group that did not undergo fixation while no cases were observed in the fixation group; however, this difference was not statistically significant.
Fixation of the right middle lobe reduced postoperative angulation of the right bronchus intermedius, which may help prevent postoperative atelectasis.
右上肺叶切除术后右中叶扭转是一种罕见但可能致命的并发症。为预防此并发症，有人建议对右中叶进行固定。本研究旨在探讨右中叶固定对术后结局及支气管变化的影响。
我们纳入了2019年至2022年因肺癌接受根治性胸腔镜辅助胸外科手术（VATS）右上肺叶切除术的患者。根据是否接受右中叶固定将参与者分组。使用术前和术后胸部计算机断层扫描图像测量支气管角度，并比较两组的术后结局和支气管变化。
该研究共纳入50例患者，其中17例（34%）接受了右中叶固定。所有手术均采用VATS进行。两组在术前特征或术后结局方面未观察到显著差异。术后，两组的右中间支气管角度均显著增加，分支角度均显著减小。未进行右中叶固定的组术后右中间支气管角度显著大于固定组（47.38°±10.98° vs. 39.41°±9.21°，p = 0.014）。未进行固定的组发生了3例肺不张，而固定组未观察到病例；然而，这种差异无统计学意义。
右中叶固定可减少术后右中间支气管的成角，这可能有助于预防术后肺不张。
