基于流域分析的解剖性部分肺切除术在早期周围型肺癌治疗中的应用

Application of the anatomical partial lobectomy based on"watershed analysis"in the treatment of early-stage peripheral lung cancer

目的探讨基于"流域分析"的解剖性部分肺切除术在早期周围型肺癌治疗中的临床疗效。方法选取2022年5月至2023年5月福建省福州肺科医院胸外科128例拟行胸腔镜下亚肺叶切除的早期周围型肺癌,术前采用信封法分为肺段组(64例)和流域组(64例)。肺段组行常规肺段切除术,流域组仅切断靶动脉或靶静脉,无需处理支气管。比较分析两组患者临床基线情况、手术指标、术后并发症等临床资料,组间比较采用独立样本t检验。结果两组患者在性别、年龄、ASA分级、有无基础病、结节特点、随访时间等方面相比较,差异均无统计学意义(χ^(2)=0.04、t=-0.09、χ^(2)=0.17、χ^(2)=0.04、χ^(2)=0.00、t=-0.98,P>0.05),具有可比性。两组在术后病理、肿瘤最大径、病理分期、切缘等方面结果相仿,差异无统计学意义(χ^(2)=2.02、t=-1.19、χ^(2)=2.02、t=-2.48,P>0.05)。流域组在手术时间、术后住院时间方面低于肺段组[(107.1±35.7)min比(143.4±38.6)ml、(4.8±1.6)d比(5.2±1.8)d,P>0.05],但差异无统计学意义。流域组在出血量、清扫淋巴结个数、术后引流时间方面低于肺段组[(17.7±9.2)ml比(27.3±22.2)ml、(2.1±0.7)min比(2.3±0.9)min、(3.1±2.1)枚比(5.5±3.8)枚,P<0.05],差异有统计学意义。结论基于"流域分析"的解剖性部分肺切除术对于早期周围型肺癌的切除安全、可行,在减少手术时间及出血量上具有一定优势。

Objective To investigate the clinical efficacy of the anatomical partial lobectomy based on"watershed analysis"in the treatment of early-stage peripheral lung cancer.Methods A prospective,randomized and controlled study was performed on 128 patients with early-stage peripheral lung cancer patients admitted to our hospital from May 2022 and May 2023.Patients were randomly divided into segmental pneumonectomy group and segmental pneumonectomy based on"watershed analysis"group by the envelope method before surgery.The segmental group underwent segmentectomy while the watershed group only cut the target artery or vein while preserving segmental bronchus.The perioperative clinical data were compared between the two groups and the significant differences between two groups were determined by independent-sample T test.ResultsThere were no statistically significant differences in gender,age,ASA grading[American Society of Anesthesiologists(ASA)Physical Status Classification System],presence or absence of underlying diseases,nodule characteristics,and follow-up time,postoperative pathology,maximum tumor diameter,pathological staging,and surgical margin between two groups(χ^(2)=0.04,t=-0.09,χ^(2)=0.17,χ^(2)=0.04,χ^(2)=0.00,t=-0.98,χ^(2)=2.02,t=-1.19,χ^(2)=2.02,t=-2.48,P>0.05).The watershed group was superior to the segment group in terms of surgical time and postoperative hospitalization days[(107.1±35.7)vs.(143.4±38.6)ml,(4.8±1.6)vs.(5.2±1.8)d,P>0.05],but the difference was not statistically significant(P>0.05).The watershed group had lower bleeding volume,less number of lymph nodes,and shorter postoperative drainage time than the segment group[(17.7±9.2)vs.(27.3±22.2)ml,(2.1±0.7)vs.(2.3±0.9)min,(3.1±2.1)vs.(5.5±3.8),P<0.05],with a statistically significant difference(P<0.05).Conclusion The anatomical partial lobectomy based on"watershed analysis"in the treatment of early-stage peripheral lung cancer is safe and feasible,which has more advantages in shortening the operation time,reducing intraoperative bleeding.