左上肺固有段切除与左上肺叶切除对患者术后肺功能的影响

Effect of left upper lung intrinsic segmentectomy and left upper lung lobectomy on postoperative pulmonary function

目的分析左上肺固有段切除术和左上肺叶切除术对患者肺功能的影响。方法回顾性分析2020年9月~2022年3月在郑州大学第一附属医院行胸腔镜下肺段切除术和肺叶切除术的肺癌患者的临床资料,根据性别、年龄、吸烟史、饮酒史、体重指数等因素进行倾向性评分匹配,其中左上肺固有段切除组和左上肺叶切除组各24例入组。比较两组的基本临床特征,术后临床指标及术后肺容积的减小比率等情况。结果术前两组的临床特征差异无统计学意义(P>0.05);术后两组的手术时间、出血量、术后监护时间、术后住院时间等相关指标差异无统计学意义(P>0.05)。术前两组的FEV1%、FVC比较,差异无统计学意义(P>0.05);术后两组的肺容积减小比率均较术前降低,虽然肺叶组肺容积减小比率高于肺段组,但差异无统计学意义(P>0.05)。结论左上肺固有段切除相比于左上肺叶切除术,并不能明显保留患者术后的肺功能。对于混杂密度的磨玻璃结节,尤其是术前病理为浸润性癌或影像学可能为浸润性癌的左上肺早期肺癌患者,应当采用指南推荐的肺叶切除术作为首选手术方案。

Objective To analyze the effects of left upper lung segmentectomy and left upper lobectomy on lung function.Methods A retrospective analysis of cases of lung cancer treated with thoracoscope lung segment resection or thoracoscope lung lobe resection were performed.From September 2020 to March 2022,cases admitted to the first affiliated hospital of Zhengzhou university were divided into the left upper lung intrinsic segmentectomy group and the left upper lung lobectomy group,according to gender,age,smoking history,drinking history and body mass index factors as propensity score matching,with 24 cases in each group.The basic clinical characteristics,postoperative clinical indicators and the ratio of postoperative lung volume reduction were compared between the two groups.Results There was no significant difference in clinical characteristics between the two groups before operation(P>0.05).There was no significant difference in operation time,blood loss,postoperative monitoring time and postoperative hospital stay between the two groups(P>0.05).There was no significant difference in FEV1%and FVC between the two groups before operation(P>0.05).The ratio of lung volume reduction in the two groups after operation was lower than that before operation.The ratio of lung volume reduction in the lobectomy group was higher than that in the segmentectomy group,but the difference was not statistically significant(P>0.05).Conclusion Compared with left upper lung lobectomy,left upper lung intrinsic segment resection dose not significantly preserve postoperative pulmonary function.Lobectomy,as recommended by the guideline,should be used as the first surgical option for ground glass nodules of mixed density,especially in patients with early left upper lung cancer whose preoperative pathological signs show invasive cancer or imaging specific manifestation may indicate invasive cancer.