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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2019, Vol. 12 ›› Issue (06) : 356 -360. doi: 10.3877/cma.j.issn.1674-6899.2019.06.010

所属专题： 经典病例； 经典病例； 文献；

论著

荧光染色法与改良膨胀萎陷法判定段间平面在解剖性肺段切除术中的病例对照研究
张彤1, 马永富1, 石渊博1, 孙天宇1, 李云婧1, 冯长江1, 潘俊伊1, 刘阳1,†()   
  1. 1. 100853　北京，解放军总医院第一医学中心胸外科
  • 收稿日期:2019-11-20 出版日期:2019-12-30
  • 通信作者: 刘阳
  • 基金资助:
    军队保健专项科研课题(14BJZ15)

Fluorescence method versus modified inflation-deflation method distinguish intersegmental plane in thoracoscopic anatomical segmentectomy

Tong Zhang1, Yongfu Ma1, Yuanbo Shi1, Tianyu Sun1, Yunjing Li1, Changjiang Feng1, Junyi Pan1, Yang Liu1,†()   

  1. 1. Department of Thoracic Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2019-11-20 Published:2019-12-30
  • Corresponding author: Yang Liu
  • About author:
    Corresponding author: Liu Yang, Email:
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引用本文：

张彤, 马永富, 石渊博, 孙天宇, 李云婧, 冯长江, 潘俊伊, 刘阳. 荧光染色法与改良膨胀萎陷法判定段间平面在解剖性肺段切除术中的病例对照研究[J/OL]. 中华腔镜外科杂志(电子版), 2019, 12(06): 356-360.

Tong Zhang, Yongfu Ma, Yuanbo Shi, Tianyu Sun, Yunjing Li, Changjiang Feng, Junyi Pan, Yang Liu. Fluorescence method versus modified inflation-deflation method distinguish intersegmental plane in thoracoscopic anatomical segmentectomy[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2019, 12(06): 356-360.

目的

相较于目前常用的改良膨胀萎陷法，探讨荧光染色法判定段间平面在胸腔镜解剖性肺段切除术中的可行性及安全性。

方法

回顾性分析解放军总医院第一医学中心胸外科2017年3月至2019年9月行胸腔镜解剖性肺段切除术的157例临床资料，其中荧光染色组60例，女41例、男19例，年龄36～76岁；改良膨胀萎陷组97组，女62例、男35例，年龄27～85岁。荧光染色组采用反向染色法，分离出预切除肺段的肺动脉分支并切断，经外周静脉快速推注吲哚菁绿25 mg行保留肺脏部分的荧光显影从而判定段间平面。改良膨胀萎陷法，在分离出预切除肺段的支气管分支并切断后，双肺通气使肺脏完全膨胀后恢复单肺通气，一段时间后可形成较明显的段间平面。记录两组的临床资料并进行统计学分析。

结果

与改良膨胀萎陷组相比，荧光染色组的段间平面形成时间更早、手术时间缩短，两组差异具有统计学意义[20 s(8～25 s)比1 008 s(884～1 200 s)，P＝0.031；(103.3±7.3)min比(132.8±10.4)min，P＝0.021]；两组的术中出血量、淋巴结清扫数目、术后置管时间、术后住院时间、并发症发生率比较，差异无统计学意义(P均>0.05)。

结论

相较于目前常用的改良膨胀萎陷法，荧光染色法术中不需反复膨肺，同样符合肿瘤学要求，是安全、有效的。

关键词: 胸腔镜, 肺段切除术, 荧光, 吲哚菁绿, 改良膨胀萎陷法
Objective

To investigate the feasibility and security of fluorescence method in thoracoscopic anatomical segmentectomy, compared with modified inflation-deflation method.

Methods

Department of thoracic surgery of the First Medical Center, Chinese PLA General Hospital from Mar. 2017 to Sep. 2019, we performed thoracoscopic anatomical segmentectomy for 157 patients (fluorescence group, 41 females and 19 males, aging from 36 to 76; modified inflation-deflation group, 62 females and 35 males, aging from 27 to 85). In the fluorescence group, to distinguish intersegmental plane, indocyanine green was injected into peripheral vein after the targeted segmental artery cut off. In the modified inflation-deflation group, after the targeted segmental bronchus cut off, the bilateral ventilation was started, and then unilateral ventilation was restored. The intersegmental plane would be formed after more than 10 minutes. Clinical data of the two groups were collected and analyzed.

Results

Compared with the modified inflation-deflation group, the fluorescence group showed shorter display time and shorter operational time [20 s(8-25)s vs 1 008 s(884-1 200)s, P=0.031, (103.3±7.3)min vs (132.8±10.4)min, P=0.021]. There were no significant differences in bleeding volume, the number of lymph node dissection, drainage time, hospitalization time and morbidity between the two groups (all P>0.05).

Conclusions

Compared with modified inflation-deflation group, it is quicker and more accurate to distinguish intersegmental plane in fluorescence group. It needn′t to inflate and deflate lungs repeatedly. Fluorescence method is safe and efficient.

Key words: Thoracoscopy, Segmentectomy, Fluorescence, Indocyanine green, Modified inflation-deflation
图1 右肺下叶前基底段的荧光染色法判定段间平面
图2 左肺上叶尖后段的改良膨胀萎陷法判定段间平面
表1 两组解剖性肺段切除术患者的一般资料比较
组别 例数 性别[例(%)] 年龄(岁，±s) 第一秒用力呼气容积(L，±s) 吸烟史[例(%)]
男 女 从不吸烟 曾经吸烟 现为吸烟
荧光染色组 60 41 (68.3) 19 (31.7) 54.5±8.7 2.6±0.6 47 (78.3) 8 (13.4) 5 (8.3)
改良膨胀萎陷组 97 62 (63.9) 35 (36.1) 55.0±10.6 2.6±0.7 75 (77.3) 18 (18.6) 4 (4.1)
统计值 ? χ2＝0.155 t＝0.330 t＝0.132 ? χ2＝1.798 ?
P值 ? 0.694 0.742 0.895 ? 0.407 ?
表2 两组解剖性肺段切除术患者的围手术期资料比较
组别 例数 手术时间(min, ±s) 术中出血量(ml, ±s) 段间平面显现时间[s, M(Q1～Q3)] 段间平面持续时间(s，±s) 淋巴结清扫数目(枚，±s)
荧光染色组 60 103.3±7.3 40.0±63.4 20 (8～25) 181.2±23.8 6.8±3.1
改良膨胀萎陷组 97 132.8±10.4 48.5±55.7 1 008 (884～1 200) － 7.6±2.4
统计值 ? t＝2.330 t＝0.849 t＝3.195 － χ2＝0.684
P值 ? 0.021 0.397 0.031 － 0.495
组别 例数 术后置管时间(d, ±s) 术后住院时间(d，±s) 并发症[例(%)]
肺泡胸膜瘘 胸腔积液 无
荧光染色组 60 4.8±2.1 6.5±1.4 6(10.0) 2(3.3) 52(86.7)
改良膨胀萎陷组 97 4.6±1.8 6.9±0.9 7(7.2) 5(5.2) 85(87.6)
统计值 ? t＝0.546 t＝0.979 ? － ?
P值 ? 0.586 0.329 ? 0.695 ?
表3 两组解剖性肺段切除术患者的病理资料比较
组别 例数 结节直径(cm, ±s) 病理类型[例(%)]
原位腺癌 微浸润型腺癌 腺泡为主型腺癌 贴壁为主型腺癌 乳头状腺癌 鳞癌
荧光染色组 60 1.2±0.7 3 (5.0) 11 (18.3) 10 (16.7) 35 (58.3) 0(0.0) 1 (1.7)
改良膨胀萎陷组 97 1.4±1.1 3 (3.1) 11 (11.3) 23 (23.7) 57 (58.8) 1 (1.0) 2 (2.1)
t值 ? 1.102 ? ? － ? ?
P值 ? 0.272 ? ? 0.687 ? ?
表4 两组解剖性肺段切除术患者的切除肺段资料比较[例(%)]
组别 例数 LS1＋2 LS1＋2＋3 LS3 LS4＋5 LS6 LS8 LS9
荧光染色组 60 9(15.0) 9(15.0) 1(1.7) 0(0.0) 2(3.3) 2(3.3) 2(3.3)
改良膨胀萎陷组 97 10(10.3) 13(13.4) 1(1.0) 8(8.2) 5(5.2) 2(2.1) 0(0.0)
组别 例数 LS10 RS1 RS2 RS3 RS6 RS8 RS9 RS10
荧光染色组 60 1(1.7) 9(15.0) 2(3.3) 2(3.3) 9(15.0) 7(11.7) 3(5.0) 2(3.3)
改良膨胀萎陷组 97 0(0.0) 14(14.4) 17(17.5) 17(17.5) 17(17.5) 4(4.1) 1(1.0) 1(1.0)
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