Yasuda Kengo, Yamasaki Masaya, Wada Toho, Fujiwara Wakako, Miyamoto Tatsuya, Matsui Shinji, Kubouchi Yasuaki, Tanaka Yugo
Division of General Thoracic Surgery and Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-Cho, Yonago, Tottori, 683-8503, Japan.
Gen Thorac Cardiovasc Surg. 2025 Jun 9. doi: 10.1007/s11748-025-02169-4.
The presence of pleural adhesions during lung cancer surgery can obstruct the surgical field and inhibit maneuverability, thereby potentially complicating the procedure. The current study examined the potential predictive factors of pleural adhesions using standard preoperative examinations for lung cancer surgery without additional assessments.
This study included 542 patients with primary lung cancer who underwent chest computed tomography scan and positron emission tomography before undergoing surgery between January 2021 and September 2024. To assess differences in lung expansion between inspiration and natural breathing, the ratio of lung computed tomography scan measurements obtained during maximal inspiration-to-lung positron emission tomography measurements during spontaneous breathing was calculated. The ratios were compared between patients with pleural adhesions and those without.
In total, 56 patients were classified under the adhesion group and 486 under the non-adhesion group. If the ratio of the distance from the lung base to the interlobar fissure, measured on coronal computed tomography scan and positron emission tomography, was ≤ 1.390, and the angle of the lung base, measured on sagittal computed tomography scan, was ≥ 40°, the incidence of pleural adhesions was significantly higher (24.0% vs. 4.7%; p < 0.01).
Standard preoperative examinations could be effective in predicting pleural adhesion.
肺癌手术过程中胸膜粘连的存在会妨碍手术视野并限制可操作性，从而可能使手术过程复杂化。本研究使用肺癌手术的标准术前检查而不进行额外评估，来探究胸膜粘连的潜在预测因素。
本研究纳入了542例原发性肺癌患者，这些患者在2021年1月至2024年9月接受手术前均接受了胸部计算机断层扫描和正电子发射断层扫描。为了评估吸气和自然呼吸时肺扩张的差异，计算了最大吸气时获得的肺部计算机断层扫描测量值与自主呼吸时肺部正电子发射断层扫描测量值的比值。比较了有胸膜粘连患者和无胸膜粘连患者的比值。
总共56例患者被归类为粘连组，486例患者被归类为非粘连组。如果在冠状位计算机断层扫描和正电子发射断层扫描上测量的从肺底部到叶间裂的距离比值≤1.390，并且在矢状位计算机断层扫描上测量的肺底部角度≥40°，则胸膜粘连的发生率显著更高（24.0%对4.7%；p<0.01）。
标准术前检查在预测胸膜粘连方面可能是有效的。
