Chen Boyang, Tang Weifeng, Chen Junhai, Kang Mingqiang, Xie Jinbiao, Wang Wu, Yang Tianbao, Huang Shijie
Department of Cardiothoracic Surgery, Affiliated Hospital of Putian University, Putian, Fujian Province, China.
Department of Esophageal Surgery, Department of Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China.
World J Surg Oncol. 2025 Jan 27;23(1):25. doi: 10.1186/s12957-025-03669-6.
Some surgeons routinely divide the inferior pulmonary ligament (IPL) during upper lobectomy. Nevertheless, the evidence remains inconclusive regarding whether dividing the IPL improves the postoperative pulmonary. This systematic review and meta-analysis aimed to assess the effects of inferior pulmonary ligament division (IPLD) during upper lobectomy.
Literature comparing IPLD and inferior pulmonary ligament preservation (IPLP) was identified and screened electronically from multiple electronic databases (data up to Nov 24. 2024). Postoperative changes in lung volume, bronchial angle, and drainage time (chest tube removed time), incidence of dead space, and postoperative pneumonia were assessed using Review Manager 5.4.1.
9 studies were identified, including two randomized controlled trials and seven retrospective case-control studies involving 1,612 patients. The present study demonstrated that: (1) IPLD may not improve dead space and lung volume after upper lobectomy. (2) IPLD significantly increased bronchial angle change after upper lobectomy on the left side while showing a tendency to increase bronchial angle change on the right side (3) IPLD did not have a statistically significant effect on postoperative drainage time and also did not reduce postoperative pneumonia.
IPLD for pulmonary function protection is unnecessary in upper lobectomy.
一些外科医生在上叶切除术中常规切断下肺韧带（IPL）。然而，关于切断IPL是否能改善术后肺部情况的证据仍不确凿。本系统评价和荟萃分析旨在评估上叶切除术中切断下肺韧带（IPLD）的效果。
通过电子检索多个电子数据库（数据截至2024年11月24日），筛选并确定比较IPLD和保留肺下韧带（IPLP）的文献。使用Review Manager 5.4.1评估肺容积、支气管角度和引流时间（胸管拔除时间）的术后变化、无效腔发生率和术后肺炎发生率。
共纳入9项研究，包括2项随机对照试验和7项回顾性病例对照研究，涉及1612例患者。本研究表明：（1）IPLD可能无法改善上叶切除术后的无效腔和肺容积。（2）IPLD显著增加了左侧上叶切除术后的支气管角度变化，而右侧则有增加支气管角度变化的趋势。（3）IPLD对术后引流时间无统计学显著影响，也未降低术后肺炎发生率。
在上叶切除术中，无需为保护肺功能而切断IPL。
