荧光胸腔镜下动脉流域亚肺叶切除术在早期周围型非小细胞肺癌中的应用

Application of watershed analysis to anatomical sublobectomy in early peripheral non-small-cell lung carcinoma by fluorescence thoracoscopy

目的探讨荧光胸腔镜下行动脉流域亚肺叶切除治疗肺磨玻璃结节(ground glass nodules,GGN)为特征的早期周围型非小细胞肺癌(no-small cell lung carcinoma,NSCLC)的临床应用价值。方法2021年9月~2022年9月在我院胸外科手术治疗影像学表现为GGN为主的早期周围型NSCLC病人81例。按荧光胸腔镜下手术方式不同分为两组,动脉流域亚肺叶切除组(简称流域组)42例,解剖性肺段切除组(简称肺段组)39例。比较两组病人的一般资料、围术期相关指标及术后并发症情况。结果两组均顺利完成手术,无围手术期死亡,流域组无中转开胸及改变术式,无误切、漏切,肺段组改变术式2例;流域组手术切缘距离为(26.24±3.87)mm,肺段组为(26.62±3.32)mm,两组比较差异无统计学意义(P>0.05)。流域组和肺段组出血量分别为32.14(20.00,50.00)ml和85.38(30,100)ml,手术时间分别为(146.76±41.51)分钟和(184.944±50.42)分钟,术后引流时间分别为2.43(2.00,3.00)天和4.05(3.00,5.00)天,两组比较差异有统计学意义(P<0.05)。流域组并发症发生率(11.91%)少于肺段组(30.77%),差异有统计学意义(P<0.05)。肺段组行术前穿刺定位25例(64.12%),流域组均未行穿刺定位;随访肿瘤均无复发。结论应用荧光胸腔镜下动脉流域亚肺叶切除术治疗周围型早期NSCLC,能简化手术步骤,精准切除病灶,同时确保肿瘤学疗效,证明本方法科学合理、安全可行。

Objective To investigate the clinical value of watershed analysis to anatomical sublobectomy in the treatment of early peripheral Non-Small-Cell Lung Carcinoma(NSCLC)characterized by Ground Glass Nodules(GGN)through fluorescence thoracoscopy.Method A total of 81 cases of early peripheral GGN-like non-small-cell lung carcinoma treated by thoracic surgery in our hospital from September 2021 to September 2022 were retrospectively studied.According to the different methods of fluorescence thoracoscopic surgery,the patients were divided into two groups.The group of anatomical sublobectomy with the watershed analysis(hereinafter,referred to as the watershed group)including 42 cases,and the anatomical pulmonary segmental resection group(hereinafter,referred to as the pulmonary segmental resection group)including 39 cases.The general surgical data,perioperative indexes and postoperative complications were compared between the two groups.Results The operations of the patients were successfully completed for both groups,without any perioperative death.For the watershed group,there were no cases that switched to thoracotomy or changed the operation style,and no cases of incision or missed incision were observed.For the pulmonary segmental resection group,there were 2 cases that changed the operation style.The surgical margin distance of the watershed group[(26.24±3.87)mm]was slightly smaller than that of the pulmonary segmental resection group[(26.62±3.32)mm].But the difference was not statistically significant(P>0.05).The amount of blood loss[32.14(20.00,50.00)ml vs 85.38(30,100)ml],operative time[(146.76±41.51)min vs(184.944±50.42)min]and postoperative drainage time[2.43(2.00,3.00)d vs 4.05(3.00,5.00)d]of the watershed group were lower than those of the pulmonary segmental resection group.And the differences were statistically significant(P<0.05).The complication rate of the watershed group(11.91%)was lower than that of the pulmonary segmental resection group(30.77%).And the difference was statistically significant(P<0.05).Totally,25 patients(64.12%)in the pulmonary segmental resection group underwent the preoperative puncture localization,but none in the watershed group.For both groups,there was no tumor recurrence during the follow-up.Conclusion The application of watershed analysis to anatomical sublobectomy in the treatment of early peripheral NSCLC by fluorescent thoracoscopy can simplify the surgical procedure,accurately remove the lesion,and ensure the curative effect of oncology.The clinical practices have proved that the approach is scientifically reasonable,safe and feasible.