全胸腔镜肺叶切除术中肺动静脉切断顺序对肺内残血量影响的研究

Effect of the amputation order of pulmonary artery and pulmonary vein on pulmonary residual blood volume in total thoracoscopic lobectomy

目的探讨全胸腔镜肺叶切除术中肺动静脉切断顺序对肺内残血量的影响。方法选取2015年6月至2019年4月北京航天总医院拟行全胸腔镜肺叶切除术的患者68例,将患者按照随机信封法分为先断动脉组和先断静脉组,每组34例。先断动脉组5例、先断静脉组4例因术中修改手术方案或标本取出时破碎无法进行后续研究排除,最终先断动脉组29例、先断静脉组30例完成研究。先断静脉组术中血管处理顺序分为先断静脉后断动脉,先断动脉组术中血管处理顺序分为先断动脉后断静脉。记录两组患者围手术期情况,测量、计算两组肺含血总质量、肺无血净质量、肺内残血量、加权后肺残血比。结果全部59例患者均手术顺利,无严重并发症及围手术期死亡,均无需输血。先断动脉组与先断静脉组轻微并发症发生率比较差异无统计学意义[27.6%(8/29)比33.3%(10/30),P>0.05]。两组手术时间、术中出血量、肺内残血量、肺含血总质量、肺无血净质量、加权后肺残血比、手术前后血红蛋白变化、术后带管时间、术后住院时间比较差异无统计学意义(P>0.05)。结论全胸腔镜肺叶切除过程中血管切断顺序对肺内残血量无影响,手术操作中可根据术中情况合理选择肺动静脉切断顺序。

Objective To investigate the effect of the amputation order of pulmonary artery and pulmonary artery on pulmonary residual blood volume in total thoracoscopic lobectomy.Methods Sixty-eight patients who were scheduled to underwent total thoracoscopic lobectomy from June 2015 to April 2019 in Beijing Aerospace General Hospital were selected.The patients were divided into first amputation pulmonary artery group and first amputation pulmonary vein group by random envelope method with 34 cases in each group.Five cases in first amputation pulmonary artery group and 4 cases in first amputation pulmonary vein group were excluded because of the procedure modification or the fragmentation of the specimen during the course of operation.In the end,29 cases were enrolled in first amputation pulmonary artery group and 30 cases in first amputation pulmonary vein group.In first amputation pulmonary vein group,all arteries were ligated before interruption of the veins;and in first amputation pulmonary artery group had a reverse sequence.The perioperative period status were recorded,and the crude pulmonary quality,dry pulmonary quality,pulmonary residual blood volume and adjusted pulmonary residual blood ratio were measured or calculated.Results All 59 patients were operated successfully.No serious complications occurred,no perioperative death occurred,and no patients needed blood transfusion.There was no statistical difference in the incidence of minor complications between first amputation pulmonary artery group and first amputation pulmonary vein group:27.6%(8/29)vs.33.3%(10/30),P>0.05.There were no statistical differences in operative time,transoperative bleeding volume,pulmonary residual blood volume,crude pulmonary quality,dry pulmonary quality,adjusted pulmonary residual blood ratio,hemoglobin difference before and after surgery,postoperative drainage time and postoperative hospitalization time between 2 groups(P>0.05).Conclusions The amputation order of pulmonary artery and pulmonary vein sequence of vessel interruption during total thoracoscopic lobectomy has no effect on the pulmonary residual blood volume,can be reasonably selected according to the intraoperative situation.