Clinical retrospective study of releasing the pulmonary ligament or not in the thoracoscope operation of the right upper lobe

doi:10.3877/cma.j.issn.2095-8773.2018.01.01

Abstract

Abstract:

Objective

To investigate the influence of whether to release the pulmonary ligament on postoperative recovery after thoracoscope operation of the right upper lobe.

Methods

Sixty-nine patients undergoing thoracoscope operation of the right upper lobe from January 2015 to July 2016 were randomly divided into two groups: 36 cases with pulmonary ligament released; 33 cases not released. Amount of thoracic cavity drainage, time of pulmonary re-expansion, removal time of drainage tube, and incidences of postoperative complications were compared between the two groups.

Results

There were no statistically significant differences of these factors between the two groups. The drainage tube removal ratio of not-releasing group at 4 and 5 days after surgery were 51.5% and 54.5%, which were significantly greater than 25.0% and 27.8% in releasing group. The difference was statistically significant (χ²=5.155, P=0.023; χ²=5.006, P=0.024). But the drainage tube removal ratio between the two groups at 6 days after surgery was not statistically significant (χ²=3.249, P=0.071).

Conclusions

Whether to release the pulmonary ligament or not has no effect on recovery after the operation of the right upper lobe resection. Not releasing the pulmonary ligament may contribute to the drainage tube removal earlier which can be applied to clinical.

Key words: Non-small cell lung cancer, Operation of lobe resection, Pulmonary ligament, Thoracoscope

Hong Guo, Yali Diao, Huangxin Fan, Qingtong Shi, Kang Feng, Qingquan Luo. Clinical retrospective study of releasing the pulmonary ligament or not in the thoracoscope operation of the right upper lobe[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(01): 1-5.

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References 24

1	支修益，石远凯，于金明. 中国原发性肺癌诊疗规范(2015年版)[J]. 中华肿瘤杂志，2015，37(1): 67-78.
2	Ettinger DS, Akerley W, Bepler G. Non-small cell lung cancer[J]. J Natl Compr Canc Nerw, 2010, 8(7):740-801.
3	许林，张治. 胸腔镜手术与肺癌[J]. 中华肿瘤外科杂志，2013, 5(3): 137-140.
4	Paul S, Ahorki NK, Sheng S, et al. Thoracoseopie lobectomy is associated with lower morbidity than open lobectomy: a propensity— matched analysis from the STS database[J]. J Thorac Cardiovasc Surg, 2010，139(2):366-378.
5	李家言. 肺韧带影像学[J]．中国医学影像技术，2015，21(2): 318-320.
6	余建群，杨志刚，杨开清，等. 肺韧带对下胸部疾病螺旋cT表现的影响及其解剖学基础[J]. 中华放射学杂志，2003, 37(1): 67- 69.
7	Tomashefski JF，Wen P, Giampoli E, et al. Pulmonary intralobar sequestration in a patient with cystic fibrosis[J]. Hum Pathol, 1997, 28(12): 1436-1439.
8	Murakami G, Adachi N, Sato I, et al. Venous drainage of the thoracic esophagus toward the pulmonary vein[J]. Okajimas Folia Anat Jpn, 1994, 71(1): 13-19.
9	Riquet M, Le Pimpec Barthes F, Souilamas R, et al. Thoracic duct tributaries from intrathoracic organs[J]. Ann Thorac Surg, 2002, 73(3): 892-898.
10	Terzi A, Furlan G, Magnanelli G, et al. Chylothorax after pleuro-pulmonary surgery: a rare but unavoidable complication[J]. Thorac Cardiovasc Surg, 1994, 42(2): 81-84.
11	Kitagawa H, Goto A, Minami M, et al. Sclerosing hemangioma of the lung with cystic appearance[J]. Jpn J Clin Oncol, 2003, 33(7): 360-363.
12	陈玉辉，林赐荣，宋兆祺，等. 左下肺叶及下肺韧带纤维组织细胞瘤一例[J]．中华放射学杂志，1993，28:627.
13	Zwischenberger JB, Savage C, Alpard SK. et al. Mediastinal transthoracic needle and core lymph node biopsy: should it replace mediastinoscopy [J]. Chest, 2002, 121(4): 1165-1170.
14	Rami Porta R, Mateu Navarro M, Gonzalez Pont G, et al. Results of the surgical treatment of pathologic bronchogenic carcinoma N2 with negative mediastinoscopy[J]. Arch Bronconeumol, 2000, 36(7): 365-370.
15	王永岗，汪良俊，张德超，等. 胸段食管鳞癌淋巴结转移特点及临床意义[J]. 中华肿瘤杂志，2000, 22(3): 241-243.
16	Khanbhai M, Dunning J, Yap KH, et al. Dissection of the pulmonary ligament during upper lobectomy: is it necessary？[J] Interact Cardiovasc Thorac Surg, 2013，17(2): 403-406.
17	Usuda K, Sagawa M, Aikawa H, et al. Do Japanese thoracic surgeons think that dissection of the pulmonary ligament is necessary after an upper lobeetomy？[J] Surg Today, 2010, 40(11): 1097-1099.
18	齐宏峰. 胸腔镜下右肺上叶切除术中松解下肺韧带对余肺术后代偿性膨胀的影响[J]．第二军医大学学报，2016，37(1):127-128.
19	陈克能，许绍发. 普通胸外科围手术期治疗手册[M]. 北京：人民卫生出版社，2007.
20	Hessami MA, Najaft F, Hatami S, et al. Volume threshold for chest tube removal: a randomized controlled trial[J]. Inj Violence Res，2009，1: 33-36.
21	Bjerregaard LS, Jensen K, Petersen RH, et al. Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml / day[J]. Eur J Cardiothorac Surg, 2014, 45 (2): 241-246.
22	Russo L, Wiechmann RJ, Magovern JA, et al. Early chest tube removal after video-assisted thoracoscopic wedge resection of the lung[J]. Ann Thorac Surg, 1998, 66(5): 1751-1754.
23	Okada MJ, Tsubota N, Yoshimum M, et al. Proposal for reasonable mediastinal lymphadenectomy in bronchogenic carcinomas: Role of subcarinal nodes in selective dissection[J]. J Thorac Cardiovasc Surg, 1998, 116(6): 949-953
24	丁宁宁，毛友生. 早期非小细胞肺癌淋巴结转移规律与清扫方式研究进展[J]. 中国肺癌杂志，2016，19(6):359-362.

临床特征		松解组(n＝36)	未松解组(n＝33)	检验值	P值
性别		?	?	χ²＝0.740	0.390
?	男性	17(47.2)	19(57.6)	?	?
?	女性	19(52.8)	14(42.4)	?	?
年龄(岁，±s)		65.2±8.3	61.4±11.1	t＝0.706	1.603
病理类型		?	?	χ²＝0.050	0.975
?	鳞癌	5	4	?	?
?	腺癌	30	28	?	?
?	其他	1	1	?	?
TNM分期		?	?	χ²＝0.266	0.876
?	Ⅰ期	33	31	?	?
?	Ⅱ期	2	1	?	?
?	ⅢA期	1	1	?	?

临床特征		松解组(n＝36)	未松解组(n＝33)	检验值	P值
性别		?	?	χ²＝0.740	0.390
?	男性	17(47.2)	19(57.6)	?	?
?	女性	19(52.8)	14(42.4)	?	?
年龄(岁，±s)		65.2±8.3	61.4±11.1	t＝0.706	1.603
病理类型		?	?	χ²＝0.050	0.975
?	鳞癌	5	4	?	?
?	腺癌	30	28	?	?
?	其他	1	1	?	?
TNM分期		?	?	χ²＝0.266	0.876
?	Ⅰ期	33	31	?	?
?	Ⅱ期	2	1	?	?
?	ⅢA期	1	1	?	?

观察指标		松解组(n＝36)	未松解组(n＝33)	检验值	P值
术后并发症[例(%)]		5(13.9)	3(9.1)	χ²＝0.380	0.534
引流量(ml，±s)		?	?	?	?
?	第1天	393.3±335.7	357.0±241.1	t＝0.513	0.610
?	第2天	264.3±172.9	246.6±216.9	t＝0.375	0.709
?	第3天	210.7±150.8	185.9±179.1	t＝0.588	0.559
?	第4天	173.0±162.8	233.5±159.0	t＝1.140	0.260
?	第5天	182.7±121.7	268.4±138.4	t＝2.024	0.050
?	第6天	160.9±101.1	192.3±99.9	t＝0.869	0.391
带管时间(d，±s)		8.6±8.0	7.4±5.8	t＝0.736	0.464
早期肺复张情况[例(%)]		?	?	χ²＝0.544	0.760
?	完全复张	21(58.3)	22(66.7)	?	?
?	复张良好	9(25.0)	7(21.2)	?	?
?	复张不良	6(16.7)	4(12.1)	?	?

观察指标		松解组(n＝36)	未松解组(n＝33)	检验值	P值
术后并发症[例(%)]		5(13.9)	3(9.1)	χ²＝0.380	0.534
引流量(ml，±s)		?	?	?	?
?	第1天	393.3±335.7	357.0±241.1	t＝0.513	0.610
?	第2天	264.3±172.9	246.6±216.9	t＝0.375	0.709
?	第3天	210.7±150.8	185.9±179.1	t＝0.588	0.559
?	第4天	173.0±162.8	233.5±159.0	t＝1.140	0.260
?	第5天	182.7±121.7	268.4±138.4	t＝2.024	0.050
?	第6天	160.9±101.1	192.3±99.9	t＝0.869	0.391
带管时间(d，±s)		8.6±8.0	7.4±5.8	t＝0.736	0.464
早期肺复张情况[例(%)]		?	?	χ²＝0.544	0.760
?	完全复张	21(58.3)	22(66.7)	?	?
?	复张良好	9(25.0)	7(21.2)	?	?
?	复张不良	6(16.7)	4(12.1)	?	?

组别	术后第4天	术后第5天	术后第6天
松解组(n＝36)	9(25.0)	10(27.8)	14(38.9)
未松解组(n＝33)	17(51.5)	18(54.5)	20(60.1)
χ²值	5.155	5.006	3.249
P值	0.023	0.024	0.071

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