Kuroda Sanae, Shimizu Nahoko, Nishikubo Megumi, Nishio Wataru
Division of Chest Surgery, Hyogo Cancer Center, 13-70, Kitaoji-Cho, Akashi City, 673-8558, Japan.
Surg Today. 2025 Feb;55(2):257-264. doi: 10.1007/s00595-024-02915-w. Epub 2024 Sep 19.
PURPOSE: Occasionally, lobes displace after lobectomy, which is referred to as "lobar shifting". This study aimed to evaluate the effect of lobar shifting on postoperative pulmonary function. METHODS: We analyzed the records of 761 patients who underwent lobectomy between 2012 and 2022. The patients were categorized based on three-dimensional computed tomography (3D-CT) images into those with (shift group: n = 510) and those without (non-shift group: n = 251) their postoperative subject bronchus shifting toward the head or dorsal side. The preservation rate of forced expiratory volume in one second (FEV1.0) was compared between the two groups. Several factors were investigated to identify the cause of lobar shifting. RESULTS: FEV1.0 preservation rates, excluding left upper lobectomy, were significantly better in the shift group than in the non-shift group (all patients: 87.9% vs. 84.9%, p < 0.001; right upper lobectomy: 90.1% vs. 85.4%, p = 0.002; right lower lobectomy: 90.0% vs. 84.5%, p = 0.002; left upper lobectomy: 82.0% vs. 83.9%, p = 0.43; left lower lobectomy: 90.0% vs. 85.2%, p = 0.01). Factors that correlated with lobar shifting included age (p < 0.001), adhesions (p < 0.001), and lobulation (p = 0.001). CONCLUSIONS: Lobar shifting may benefit postoperative pulmonary function, excluding after left upper lobectomy. Morphological factors contribute to lobar shifting.
目的:肺叶切除术后偶尔会出现肺叶移位,即“肺叶移位”。本研究旨在评估肺叶移位对术后肺功能的影响。 方法:我们分析了2012年至2022年间接受肺叶切除术的761例患者的记录。根据三维计算机断层扫描(3D-CT)图像,将患者分为术后患侧支气管向头侧或背侧移位的患者(移位组:n = 510)和未移位的患者(非移位组:n = 251)。比较两组一秒用力呼气容积(FEV1.0)的保留率。研究了几个因素以确定肺叶移位的原因。 结果:除左上肺叶切除术后外,移位组的FEV1.0保留率显著高于非移位组(所有患者:87.9%对84.9%,p < 0.001;右上肺叶切除术:90.1%对85.4%,p = 0.002;右下肺叶切除术:90.0%对84.5%,p = 0.002;左上肺叶切除术:82.0%对83.9%,p = 0.43;左下肺叶切除术:90.0%对85.2%,p = 0.01)。与肺叶移位相关的因素包括年龄(p < 0.001)、粘连(p < 0.001)和分叶(p = 0.001)。 结论:除左上肺叶切除术后外,肺叶移位可能有利于术后肺功能。形态学因素导致肺叶移位。
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