A novel video-assisted anatomic segmentectomy technique: Selective segmental inflation via bronchofiberoptic jet followed by cautery cutting
A novel video-assisted anatomic segmentectomy technique: Selective segmental inflation via bronchofiberoptic jet followed by cautery cutting
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DOI：
10.1016/j.jtcvs.2006.11.005
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发表时间：
2007-03-01
影响因子：
6
通讯作者：
Tsubota, Noriaki
中科院分区：
文献类型：
--
作者：
Okada, Morihito;Mimura, Takeshi;Tsubota, Noriaki
目的：节段性切除术是近年来对小肺癌施行的一种保留解剖实质的切除术，是胸外科医生常用的一种手术方式。我们开发了一种新的技术，改善了节段间边界的识别，并在本研究中对其临床应用进行了评估。方法：在纤维支气管镜下，选择性地对负担过重的支气管处进行喷射通风，以便在要切除的充气段和要保留的排空区之间形成一个解剖平面。2004年4月至2006年6月，对52例临床诊断为T1、N0、M0、直径小于或等于2 cm的周围型癌患者，在电视辅助下进行节段性切除，称为混合式电视胸段切除术，采用不带吻合器的电灼术分割选择性喷射通气检测到的节段间平面。中位手术时间为155分钟(85~225分钟)，术中出血量为60毫升(10~210毫升)。并发症发生率为13.5%(7/52)，最常见的并发症为漏气。术后漏气和胸腔引流的中位时间分别为1天和3天。没有住院死亡病例。手术切缘无局部复发，但纵隔淋巴结复发1例，脑转移1例。结论：一种新的电视辅助肺癌节段切除术技术具有临床应用价值。选择性节段充气可快速、轻松地提供明显的节段间平面，允许在通风节段中保持真实的边缘距离。尽管采用了微创入路，但由于只扩大了要切除的部分，而不是整个肺叶，因此有可能采用合适的手术切面。
Objective: Segmentectomy is an anatomic parenchyma-sparing resection that is recently being performed for small-sized lung carcinoma and constitutes a useful procedure in a thoracic surgeon's armamentarium. We have generated a new technique that improves the identification of the intersegmental border and whose clinical utility we evaluate in this study.Methods: Under bronchofiberscopy, jet ventilation is selectively applied to the burdened bronchus to develop an anatomic plane between the inflated segment to be resected and the deflated area to be preserved. From April 2004 to June 2006, 52 consecutive patients with a clinical T1 N0 M0 peripheral cancer 2 cm or smaller underwent video-assisted segmental resection called hybrid VATS segmentectomy in which electrocautery with no stapler was used to divide the intersegmental plane detected by selective jet ventilation.Results: Complete resection was achieved in all patients. The median operative time and bleeding during the operation were 155 minutes (range 85-225 minutes) and 60 mL (range 10-210 mL), respectively. The complication rate was 13.5% (7/52), and the most common was concerning air leak. The median duration of postoperative air leak and chest tube drainage was 1 day and 3 days, respectively. There were no in-hospital deaths. There was one case of mediastinal lymph node recurrence and another of metastasis to the brain although there was no case of local recurrence in the surgical margin area.Conclusions: A novel video-assisted segmentectomy technique for lung cancer is clinically useful. Selective segmental inflation provides an obvious intersegmental plane quickly and easily, allowing a real margin distance in the ventilated segment. Despite the minimally invasive approach, since only the segment to be resected and not the entire lobe is expanded, an appropriate surgical view is possible.