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中华腔镜外科杂志(电子版) ›› 2023, Vol. 16 ›› Issue (02) : 85 -90. doi: 10.3877/cma.j.issn.1674-6899.2023.02.005

论著

以肺亚段为解剖单位的精准肺外科手术策略的初步报道
赵志鹏1, 马永富1, 冯长江1, 张猛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:2023-02-19 出版日期:2023-04-30
  • 通信作者: 刘阳

A single-center retrospective analysis of a surgical strategy based on pulmonary sub-segments

Zhipeng Zhao1, Yongfu Ma1, Changjiang Feng1, Meng Zhang1, Yang Liu1,()   

  1. 1. Department of Thoracic Surgery, The First Medical Center, The Chinese PLA General Hospital, Beijing 100853, China
  • Received:2023-02-19 Published:2023-04-30
  • Corresponding author: Yang Liu
引用本文:

赵志鹏, 马永富, 冯长江, 张猛, 刘阳. 以肺亚段为解剖单位的精准肺外科手术策略的初步报道[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(02): 85-90.

Zhipeng Zhao, Yongfu Ma, Changjiang Feng, Meng Zhang, Yang Liu. A single-center retrospective analysis of a surgical strategy based on pulmonary sub-segments[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2023, 16(02): 85-90.

目的

探索以肺亚段为解剖单位规划亚肺叶切除的手术策略围手术期安全性。

方法

回顾性分析2021年2月至2022年2月期间于解放军总医院第一医学中心胸外科完成的150例患者资料,其中以肺亚段为解剖单位的手术策略执行手术29例、肺段切除术74例、肺叶切除术47例,比较围手术期及随访数据。

结果

所有组均无围手术期死亡,随访12个月均未见肿瘤复发进展。在切除的肺亚段数量、切除的肺体积、术中清扫的淋巴结区域、清扫的淋巴结数目比较中,肺亚段组与肺段组之间差异无统计学意义,肺亚段组与肺段组均少于肺叶组。肺亚段组的手术时间、术中使用的切割缝合器数量高于肺段组与肺叶组。三组之间的术中出血量、术后置管时间、术后住院时间差异均无统计学意义。主要并发症为肺部漏气,三组之间差异无统计学意义。

结论

以肺亚段为解剖单位的手术策略执行手术难度较高,在实践中安全可行,可以应用于符合亚肺叶切除术指征的患者。

Objective

To explore the perioperative safety of a sublobar resection strategy based on using lung subsegments as anatomical units.

Methods

Review and analyze the clinical data of 150 patients with pulmonary nodules who underwent surgery in the First Medical Center of the PLA General Hospital from Feb. 2021 to Feb. 2022, including 29 surgeries performed with a surgical strategy using lung subsegments as surgical anatomical units, 74 resections with lung segments as units, and 47 lobectomies. Their perioperative and follow-up data were compared.

Results

There were no perioperative deaths in all groups, and no tumor recurrence progression was seen in any of the groups at 12 months of follow-up. Among the three groups, there was no significant statistical difference in gender, age, body mass index, intraoperative blood loss, postoperative pulmonary leakage or postoperative hospitalization days. There were statistical differences in volume of remoted pulmonary tissue, number of subsegments involved, surgery duration and numbers of stapling devices.

Conclusions

The surgical strategy of using lung subsegments as anatomical units is difficult, safe and feasible in practice, and can be applied to patients who meet the indications for sublobar resection.

图1 数字三维重建工作注:A.以肺亚段为划分单位的3D数字重建模型;B.以肺亚段为划分单位的3D打印模型。
图2 术前进行CT引导下肺结节穿刺定位注:A.术前在CT引导下进行肺穿刺,置入微弹簧圈定位肺结节位置;B.术前定位的微弹簧圈在术中固定于肺表面作为标记的影像。
图3 "通气-萎陷法"显露段间平面注:在离断靶段肺组织的气管、动脉、静脉后,以纯氧通气将肺完全膨胀,待肺塌陷后显示出目标肺段的边界。A.右S1+S2a的段间平面显示;B.左S6b+S8a的段间平面显示。
表1 三组肺癌患者术前资料
表2 三组肺癌患者围手术期资料
图4 三组肺癌患者术后肺总体积随时间变化的趋势
1
Zheng R, Zhang S, Wang S, et al. Lung cancer incidence and mortality in china: updated statistics and an overview of temporal trends from 2000 to 2016 [J]. Journal of the National Cancer Center, 2022, 2(3): 139-147.
2
Zheng R, Zhang S, Zeng H, et al. Cancer incidence and mortality in china, 2016 [J]. Journal of the National Cancer Center, 2022, 2(1): 1-9.
3
Sawabata N, Miyaoka E, Asamura H, et al. Japanese lung cancer registry study of 11,663 surgical cases in 2004: demographic and prognosis changes over decade [J]. Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer, 2011, 6(7): 1229-1235.
4
Asamura H, Goya T, Koshiishi Y, et al. A japanese lung cancer registry study: prognosis of 13,010 resected lung cancers [J]. Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer, 2008, 3(1): 46-52.
5
Wang P, Wang S, Liu Z, et al. Segmentectomy and wedge resection for elderly patients with stage i non-small cell lung cancer: a systematic review and meta-analysis[J]. J Clin Med, 2022, 11(2):294.
6
Sienel W, Dango S, Kirschbaum A, et al. Sublobar resections in stage ia non-small cell lung cancer: segmentectomies result in significantly better cancer-related survival than wedge resections [J]. Eur J Cardiothorac Surg, 2008, 33(4): 728-734.
7
Horinouchi H, Nomori H, Nakayama T, et al. How many pathological T1N0M0 non-small cell lung cancers can be completely resected in one segment. special reference to high-resolution computed tomography findings [J]. Surg Today, 2011, 41(8): 1062-1066.
8
Chen L, Gu Z, Lin B, et al. Pulmonary function changes after thoracoscopic lobectomy versus intentional thoracoscopic segmentectomy for early-stage non-small cell lung cancer [J]. Transl Lung Cancer Res, 2021, 10(11): 4141-4151.
9
Wu W, He Z, Xu J, et al. Anatomical pulmonary sublobar resection based on subsegment [J]. Ann Thorac Surg, 2021, 111(6): 447-450.
10
吴卫兵,夏阳,许晶,等. 3D导航胸腔镜联合肺亚段切除术治疗肺段间结节的对比研究 [J]. 南京医科大学学报(自然科学版), 2018, 38(10): 1424-1427.
11
黄晶晶,陈志鹏,卞承禹,等. 以肺亚段为解剖单元的肺结节手术策略及临床结果的单中心回顾性分析 [J]. 中国胸心血管外科临床杂志2022, 29(1): 36-43.
12
Ohtsuka T, Goto T, Anraku M, et al. Dissection of lung parenchyma using electrocautery is a safe and acceptable method for anatomical sublobar resection [J]. J Cardiothorac Surg, 2012, 7: 42.
13
李波,王宜主,胡彬,等. 三维影像重建支气管、血管引导胸腔镜精准肺段、肺亚段切除段间区域结节的策略探讨 [J]. 肿瘤预防与治疗2019, 32(8): 711-717.
14
吴涛,刘建,詹必成. 胸腔镜下肺亚段切除术临床可行性研究 [J]. 蚌埠医学院学报2022, 47(5): 608-611,615.
15
Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. lung cancer study group [J]. Ann Thorac Surg, 1995, 60(3): 615-622.
16
Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial [J]. Lancet, 2022, 399(10335): 1607-1617.
17
Altorki N, Wang X, Kozono D, et al. Lobar or sublobar resection for peripheral stage ia non-small-cell lung cancer [J]. N Engl J Med, 2023, 388(6): 489-498.
18
Nomori H, Shiraishi A, Cong Y, et al. Differences in postoperative changes in pulmonary functions following segmentectomy compared with lobectomy [J]. Eur J Cardiothorac Surg, 2018, 53(3): 640-647.
19
翟振州,赵军,李畅,等. 胸腔镜肺叶切除术后肺容积减少与患者肺功能丢失的相关性分析 [J]. 中华肺癌杂志2022, 25(1): 21-25.
20
Okami J, Ito Y, Higashiyama M, et al. Sublobar resection provides an equivalent survival after lobectomy in elderly patients with early lung cancer [J]. Ann Thorac Surg, 2010, 90(5): 1651-1656.
21
Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: safety results of a randomized trial [J]. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
22
Lin YJ, Chiang XH, Lu TP, et al. Thoracoscopic lobectomy versus sublobar resection for pstage i geriatric non-small cell lung cancer [J]. Front Oncol, 2021, 11: 777-590.
23
朱燚宁,李志华,何志成,等. 胸腔镜下肺亚段切除术的临床对比研究 [J]. 南京医科大学学报(自然科学版), 2020, 40(6): 870-874.
24
Chen X, Jin R, Xiang J, et al. Methods for dissecting intersegmental planes in segmentectomy: a randomized controlled trial [J]. Ann Thorac Surg, 2020, 110(1): 258-264.
25
Li D, Deng C, Wang S, et al. Ten-year follow-up results of pure ground-glass opacity-featured lung adenocarcinomas after surgery [J]. Ann Thorac Surg, 2023, 4975(23):31.
26
Nomori H, Ohba Y, Shibata H, et al. Required area of lymph node sampling during segmentectomy for clinical stage ia non-small cell lung cancer [J]. J Thorac Cardiovasc Surg, 2010, 139(1): 38-42.
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