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

doi:10.3877/cma.j.issn.1674-6899.2019.06.010

Abstract

Abstract:

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

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]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2019, 12(06): 356-360.

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Figures/Tables 6

References 19

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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(%)]
组别	例数	男	女	年龄(岁， ±s)	第一秒用力呼气容积(L， ±s)	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	?

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(%)]
组别	例数	男	女	年龄(岁， ±s)	第一秒用力呼气容积(L， ±s)	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	?

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(%)]
组别	例数	术后置管时间(d, ±s)	术后住院时间(d， ±s)	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	?

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(%)]
组别	例数	术后置管时间(d, ±s)	术后住院时间(d， ±s)	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	?

组别	例数	结节直径(cm, ±s)	病理类型[例(%)]
组别	例数	结节直径(cm, ±s)	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		?	?

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