可视化精准膨肺用于胸腔镜肺段切除术中确定段间平面的效果

Efficacy of visualized precise lung expansion for determining intersegmental plane in thoracoscopic segmentectomy

目的评价可视化精准膨肺用于胸腔镜肺段切除术中确定段间平面的效果。方法择期全身麻醉下拟行胸腔镜肺段切除术患者64例,性别不限,年龄33~77岁,BMI 16~34 kg/m^(2),ASA分级Ⅰ或Ⅱ级,术前均采用三维CT支气管血管重建肺血管、支气管及虚拟的肺段间平面。采用随机数字表法分为2组(n=32):可视化精准膨肺组(V组)和改良膨胀萎陷组(E组)。V组采用可视化精准膨肺确定段间平面,E组采用改良膨胀萎陷法确定段间平面。记录2组患者术中段间平面确定时间、靶段支气管辨认及处理时间、麻醉时间、手术时间、术后漏气、肺不张、发热、肺部感染发生情况、术后24 h引流量、引流管拔除时间和住院时间。结果与E组比较,V组段间平面确定时间、靶段支气管辨认及处理时间、麻醉时间和手术时间缩短(P<0.05);2组患者术后24 h引流量、引流管拔除时间、住院时间和术后肺部并发症发生率比较差异无统计学意义(P>0.05)。结论与改良膨胀萎陷法相比,可视化精准膨肺可显著缩短胸腔镜肺段切除术中段间平面确定时间。

Objective To evaluate the efficacy of visualized precise lung expansion for determining the intersegmental plane in thoracoscopic segmentectomy.Methods Sixty-four American Society of Anesthesiologists Physical Status classificationⅠorⅡpatients,regardless of gender,aged 33-77 yr,with body mass index of 16-34 kg/m^(2),undergoing elective thoracoscopic segmentectomy under general anesthesia,were included.They were preoperatively reconstructed with 3D CT bronchovascularization to reconstruct the pulmonary vasculature,bronchus,and the virtual intersegmental planes of the lungs.The patients were divided into 2 groups(n=32 each)using a random number table method:visualized precise lung expansion group(group V)and modified expansion and atrophy group(group E).Group V used visualized precision lung expansion to determine the intersegmental planes,and group E used the modified expansion and atrophy method to determine the intersegmental planes.The intraoperative intersegmental plane determination time,target segmental bronchus identification and treatment time,anesthesia time,operation time,postoperative air leakage,pulmonary atelectasis,fever,occurrence of lung infection,postoperative 24 h drainage volume,drain removal time and hospitalization time were recorded in the two groups.Results Compared with group E,the intersegmental plane determination time,target segment bronchial identification and treatment time,anesthesia time and operation time were significantly shortened in group V(P<0.05).There were no significant differences between groups in the 24 h postoperative drainage volume,drain removal time,hospitalization time or incidence of postoperative pulmonary complications(P>0.05).Conclusions Compared with the modified expansion and atrophy method,visualized precise lung expansion can effectively shorten the intersegmental plane determination time in thoracoscopic segmentectomy.