Watanabe Hikaru, Shiono Satoshi, Adachi Hiroyuki, Takahashi Nobumasa, Morohoshi Takao, Yamamoto Taketsugu, Endo Makoto, Saito Yuichi, Oyamada Shunsuke, Sawabata Noriyoshi
Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
Division of Thoracic Surgery, Department of Surgery, Yokohama City University, Yokohama, 236-0004, Japan.
Sci Rep. 2025 Jul 21;15(1):26475. doi: 10.1038/s41598-025-12038-y.
This study was performed to assess the impact of different surgical approaches on postoperative air leak and outcomes in patients undergoing pulmonary resection. This was a post hoc analysis of the ILO1805 trial, a multicenter prospective observational study conducted across 21 Japanese institutions. Data from 1168 patients who underwent anatomical pulmonary resection with a skin incision of ≤ 8 cm were analyzed. Patients were grouped based on the surgical approach: thoracoscopic surgery or minimally invasive open surgery. Propensity score matching was used to balance the groups. Logistic regression models were employed to identify independent factors associated with early-phase postoperative air leakage (E-AL). E-AL was observed in 290 (24.8%) patients. Factors associated with leakage included male sex (p < 0.001), body mass index of < 18.5 kg/m (p = 0.023), pleural adhesions (p < 0.001), and the use of fibrin sealant (p < 0.001). The incidence of E-AL was significantly higher in the thoracoscopic surgery group than in the minimally invasive open surgery group (33.8% vs. 16.9%, p < 0.001). The durations of air leakage and drainage were significantly shorter in the minimally invasive open surgery group (p = 0.008 and p < 0.001, respectively). Male sex, body mass index of < 18.5 kg/m, pleural adhesions, thoracoscopic surgery, and fibrin sealant use were associated with E-AL. Minimally invasive open surgery may more effectively control E-AL, leading to shorter durations of postoperative air leakage and drainage.
本研究旨在评估不同手术方式对肺切除患者术后漏气及预后的影响。这是对ILO1805试验的事后分析，该试验是一项在21家日本机构进行的多中心前瞻性观察研究。分析了1168例行皮肤切口≤8 cm的解剖性肺切除患者的数据。根据手术方式将患者分组：胸腔镜手术或微创开放手术。采用倾向评分匹配法使各组达到平衡。采用逻辑回归模型确定与术后早期漏气（E-AL）相关的独立因素。290例（24.8%）患者出现E-AL。与漏气相关的因素包括男性（p<0.001）、体重指数<18.5 kg/m（p= 0.023）、胸膜粘连（p<0.001）和使用纤维蛋白密封剂（p<0.001）。胸腔镜手术组E-AL的发生率显著高于微创开放手术组（33.8%对16.9%，p<0.001）。微创开放手术组的漏气和引流持续时间显著缩短（分别为p=0.008和p<0.001）。男性、体重指数<18.5 kg/m、胸膜粘连、胸腔镜手术和使用纤维蛋白密封剂与E-AL相关。微创开放手术可能更有效地控制E-AL，导致术后漏气和引流持续时间缩短。
