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

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

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1008 s(884~1200 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。

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 1008 s(884-1200)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.