Iioka S, Nezu K, Tojo T, Kushibe K, Sawabata Y, Kawachi K, Kitamura S
Third Department of Surgery, Nara Medical University, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Dec;41(12):2333-40.
In 58 patients who underwent pneumonectomy, the stumps of the main bronchus were sutured manually (by the Sweet method in 13, the Overholt method in 12, and the modified Overholt method in 8) or with machines (TA-30 + S method in 15, TA-30 + O method in 10), and the methods to close the stump were evaluated according to the outcome and postoperative endoscopic findings. Cancer was positive at the stump in 3, and rupture of the membranous portion was observed in 1 in the mechanical suture group. Bronchial fistula was observed in 2 (12%) of the 25 patients in the mechanical suture group but in none of the 33 patients in the manual suture group. The line of closure of the bronchial stump observed by endoscopy was perpendicular to the crest at the tracheal bifurcation in patients sutured by the Sweet or TA-30 + S method, angulated in a chevron shape in many of those sutured by the Overholt method and those sutured by TA-30 + O method, and parallel to the crest in part of those sutured by Overholt method and those sutured by modified Overholt method. The mucosa at the stump was uneven in many patients who showed chevron shaped closure lines. By the modified Overholt method, the wall of the main bronchus could be resected more extensively, the mucosa at the stump was smooth, and the airway lumen showed no marked deformation.(ABSTRACT TRUNCATED AT 250 WORDS)
在58例行肺切除术的患者中，主支气管残端采用手工缝合（13例采用Sweet法，12例采用Overholt法，8例采用改良Overholt法）或机器缝合（15例采用TA-30 + S法，10例采用TA-30 + O法），并根据术后结果和内镜检查结果对残端闭合方法进行评估。3例残端癌呈阳性，机械缝合组有1例观察到膜部破裂。机械缝合组25例患者中有2例（12%）发生支气管瘘，而手工缝合组33例患者中无一例发生。在内镜检查中，采用Sweet法或TA-30 + S法缝合的患者，支气管残端的闭合线与气管分叉处的嵴垂直；采用Overholt法和TA-30 + O法缝合的患者，许多闭合线呈人字形；采用Overholt法和改良Overholt法缝合的部分患者，闭合线与嵴平行。许多显示人字形闭合线的患者残端黏膜不平整。采用改良Overholt法可更广泛地切除主支气管壁，残端黏膜光滑，气道管腔无明显变形。（摘要截取自250字）
