Modified inflation-deflation for 146 thoracscopic cone-shaped segmentectomies
10.3760/cma.j.issn.1001-4497.2017.09.002
- VernacularTitle:应用改良膨胀萎陷法行胸腔镜锥式肺段切除术146例
- Author:
Weibing WU
1
;
Quan ZHU
;
Wei WEN
;
Jun WANG
;
Jing XU
;
Xinfeng XU
;
Xianglong PAN
;
Liang CHEN
Author Information
1. 210029,南京医科大学第一附属医院
- Keywords:
Coin lesion,pulmonary;
Inflation-deflation;
Thoracoscopy;
Pneumonectomy
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2017;33(9):517-521
- CountryChina
- Language:Chinese
-
Abstract:
Objective This study applied " modified inflation-deflation" to identify the intersegmental plane and explored a method to remove pulmonary segments from the lobe on the basis of cone-shaped principle."Cone-shaped" Segmentectomy includes anatomical separation of the hilum(conical tip) and the intersegmental plane(undissociative conical surface).The feasibility was evaluated.Methods We retrospectively reviewed 146 patients with peripheric pulmonary nodules who underwent cone-shaped segmentectomy between September 2013 and August 2016.Under the guidance of preoperative 3D-CTBA (three-dimensional computed tomography bronchography and angiography)the targeted bronchi and arteries were dissected.The intersegmental plane was identified by " modified inflation-deflation" method.The inflation-deflation interface was anatomically separated from hilum to distal region along the intersegmental veins,while leaving 1-2 cm in thickness from far end.The residual intersegmental parenchyma was then dissected using endo staplers.Mean folhow-up was 20.4 months.Results Sixty two single segmentectomies,38 combined segmentectomies,43 subsegmentectomies and 3 subsubsegmentectonies were performed.Twelve diagnoses of benign nodule,15 diagnoses of atypical adenomatous hyperplasia,6 diagnoses of metastatic carcinona and 113 diagnosis of primary puhmonary cancer were confirmed pathologically." Modified inflation-deflation" spent (12.5 ±6.4)minutes to show the clear inflation-deflation line.All the targeted bronchi and arteries were dissected precisely and the intersegmental veins were preserved.All the preserved adjacent segments kept approximately original shape after inflated.The tumor size was(1.4 ±0.7)cm,the surgical margin width was(2.5 ± 1.6)cm.The depth of the separated intersegmental plane was(4.2 ±1.7)cm,and the width of the plane was(6.5 ± 2.2)cm.The operative time was(158.5 ± 42.6)min,the volume of hemorrhage was(25.2 ± 15.7) ml,the postoperative hospital stay was (5.2 ± 2.2) days.The total incidence of complications was 5.5％ (8/146).No death within 30 days occurred.Among 113 primary pulmonary cancers,there were 35 T0 N0M0(adenocarcinoma in situ) and 78 T1a No M0 non-small-cell lung cancers.One patient had local recurrence,and no death occurred during follow-up period.Conclusion Modified inflation-deflation can show clear inflation-deflation line to identify the intersegmental plane.Thoracscopic cone-shaped segmentectomy can achieve a complete anatomical segmentectomy.
