Annals of thoracic surgery short reports最新文献

Pulmonary Complications After Cardiac Surgical Procedures: A Tertiary Centre Audit of Elective and Urgent Cases 心脏外科手术后的肺部并发症：三级中心对选择性和紧急病例的审计

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.05.021

Usha Gurunathan FANZCA , Vincent Loo MBBS , Rishendran Naidoo FRACS , Sayonne Sivalingam MBBS , Stephanie Yerkovich PhD, MBiostats , Daniel Mullany FCICM, PhD

Background

Inadequate time for preoperative optimization can lead to adverse outcomes after urgent cardiac surgical procedures. In this audit, we compared the incidence of postoperative pulmonary complications (PPCs) and other adverse outcomes after elective and urgent cardiac surgical procedures.

Methods

Adult patients who underwent nonemergency open heart surgical procedures were included. PPCs were defined as a composite of atelectasis, pneumonia, acute respiratory distress syndrome, respiratory failure, and pulmonary aspiration. Logistic regression analysis identified factors associated with PPCs. Other pulmonary and systemic complications were examined.

Results

In a sample of 6138 patients, PPCs were observed in 1996 (32.5%) participants. The urgent group had higher rates of pneumonia, respiratory failure, pleural effusion, and pulmonary embolism compared with elective patients (P < .001). Mild and moderate-severe respiratory diseases were associated with PPCs (adjusted odds ratio [OR], 1.34; 95% CI, 1.14-1.58; P < .001 and OR, 1.66; 95% CI, 1.32-2.09; P < .001, respectively). Other associated factors included age (P = .006), coronary artery bypass surgery, obesity, reduced left ventricular ejection fraction, preoperative creatinine level, and perfusion time (P < .001).

Conclusions

Pulmonary complications increased after urgent compared with elective cardiac surgical procedures, with a higher incidence of pneumonia, respiratory failure, pleural effusion, and pulmonary embolism.

背景：术前优化时间不足可能导致紧急心脏外科手术后的不良后果。在这次审计中，我们比较了选择性和紧急心脏外科手术后的术后肺部并发症（PPCs）和其他不良后果的发生率。方法研究对象为接受非急诊心内直视手术的成年患者。PPCs被定义为肺不张、肺炎、急性呼吸窘迫综合征、呼吸衰竭和肺误吸的复合症状。Logistic回归分析确定了与PPCs相关的因素。检查其他肺部和全身并发症。结果6138例患者中，1996例（32.5%）出现PPCs。急诊组肺炎、呼吸衰竭、胸腔积液和肺栓塞的发生率高于择期组（P < 0.001）。轻度和中重度呼吸系统疾病与PPCs相关（校正优势比[OR]为1.34；95% CI为1.14-1.58;P < 0.001； OR为1.66；95% CI为1.32-2.09;P < 0.001）。其他相关因素包括年龄（P = 0.006）、冠状动脉搭桥手术、肥胖、左室射血分数降低、术前肌酐水平和灌注时间（P < 0.001）。结论与择期心脏外科手术相比，急诊手术后肺部并发症增加，肺炎、呼吸衰竭、胸腔积液和肺栓塞的发生率更高。

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引用次数: 0

Latin America's Cardiovascular Scientific Surgeons: A 20-Year Visual and Bibliometric Journey of Resilience 拉丁美洲的心血管科学外科医生：20年的视觉和文献计量学韧性之旅

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.05.022

W. Samir Cubas MD, MSc , Maximiliano Hernandez MD , Santiago Cubas MD , Carolina Sosa Vota MD , Juan Andrés Montero MD , Gerardo Soca MD, MSc , Victor Dayan MD, PhD

Background

The academic and research contributions of cardiovascular scientific surgeons in Latin America have remained largely unnoticed. This study analyzes the bibliometric production of cardiovascular scientific surgeons over the past 20 years and its impact on Latin American cardiovascular surgery.

Methods

A bibliometric-visual study was conducted using the Scopus database (2004-2024) with 95 major thesauri in Latin American cardiovascular surgery. Data on publications, authorship, citations, trends, collaborative networks, journals, topics, sponsorship, and economic development factors were analyzed using the R bibliometrix package and Stata software.

Results

A total of 8559 publications and 47,171 authors (2.5% of global output) were analyzed, with 77.41% being original articles or case reports. Brazil led scientific production (47.26%), with international coauthorship at 33.12%. The most cited journal was the Brazilian Journal of Cardiovascular Surgery (quartile 3). Coronary-valvular surgery (56.17%) was the predominant topic. Despite a 61.1% drop in 2023-2024, predictive models suggest recovery by early 2025, surpassing previous levels (P = .0001). A moderate correlation between scientific production and GDP per capita was found (P = .0024).

Conclusions

This is the first bibliometric analysis of cardiovascular scientific surgeons in Latin America, highlighting significant growth despite challenges. Predictive models suggest a potential for the highest production in 20 years by 2025 in the post-pandemic era. Stronger research policies, increased funding, and enhanced collaboration are essential to sustain growth.

拉丁美洲心血管科学外科医生的学术和研究贡献在很大程度上仍未得到重视。本研究分析了过去20年心血管科学外科医生的文献计量学成果及其对拉丁美洲心血管外科的影响。方法采用Scopus数据库（2004-2024）对拉丁美洲心血管外科95种主要词典进行文献计量学视觉研究。使用R bibliometrix软件包和Stata软件分析了出版物、作者、引用、趋势、合作网络、期刊、主题、赞助和经济发展因素的数据。结果共分析论文8559篇，作者47171位，占全球论文总产出的2.5%，其中77.41%为原创文章或病例报告。巴西的科研产出领先（47.26%），国际合著率为33.12%。被引用最多的期刊是《巴西心血管外科杂志》（四分位数3）。冠状动脉瓣膜手术占56.17%。尽管在2023-2024年期间下降了61.1%，但预测模型显示，到2025年初，经济将复苏，超过之前的水平（P = 0.0001）。科学产出与人均GDP之间存在中等相关性（P = 0.0024）。这是对拉丁美洲心血管科学外科医生的首次文献计量分析，强调了尽管面临挑战，但仍有显著增长。预测模型显示，到2025年，在大流行后时代，产量可能达到20年来的最高水平。加强研究政策、增加资助和加强合作对于维持增长至关重要。

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引用次数: 0

Is Robotic-Assisted Surgery Associated With Receipt of Guideline-Directed Lymph Node Sampling in Wedge Resection for Early-Stage NSCLC? 在早期NSCLC楔形切除术中，机器人辅助手术是否与接受指南指导的淋巴结取样有关？

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.06.029

Isheeta Madeka MD , Gregory L. Whitehorn BS , Annie Ho MS , Anurag Ishwar BS , Sneha Alaparthi MD , Tyler R. Grenda MD , Nathaniel R. Evans III MD , Olugbenga T. Okusanya MD

Background

Recent studies have shown a high-quality wedge resection to be equivalent to lobectomy for small, early-stage non-small cell lung cancer (NSCLC). High-quality wedge resections include compliance with 3+1 lymph node sampling (LNS). We aimed to evaluate whether robotic-assisted wedges are more likely to comply with 3+1 LNS.

Methods

The Society of Thoracic Surgeons General Thoracic Database was queried for patients with clinical T1 N0 M0 NSCLC who underwent wedge resection with LNS between July 2021 and January 2023. Multivariable regression was used to examine factors associated with 3+1 LNS.

Results

A total of 4162 patients were identified; 1815 (43.6%) underwent 3+1 LNS. Patients in the 3+1 LNS group were less likely to undergo open operations (4.6% vs 6.0%) or video-assisted thoracoscopic surgery (VATS) (40.2% vs 60.8%) (P < .001). The robotic approach had the largest association with compliance (vs VATS; odds ratio, 2.53; 95% CI, 2.22-2.90; P < .001).

Conclusions

Less than one-half of patients with early-stage NSCLC who were treated with wedge resection satisfied 3+1 LNS. Patients who underwent robotic-assisted wedge resection were 2.5 times more likely to undergo guideline-concordant LNS. The robotic approach was the most significant factor in achieving 3+1 LNS.

最近的研究表明，对于小的、早期的非小细胞肺癌（NSCLC），高质量的楔形切除术与肺叶切除术相当。高质量的楔形切除包括符合3+1淋巴结取样（LNS）。我们的目的是评估机器人辅助的楔形是否更有可能符合3+1 LNS。方法查询美国胸外科学会（Society of Thoracic Surgeons）胸椎数据库中于2021年7月至2023年1月间行楔形切除联合LNS的临床T1 N0 M0 NSCLC患者。采用多变量回归分析与3+1 LNS相关的因素。结果共检出4162例患者；1815例（43.6%）行3+1次LNS。3+1 LNS组患者较少接受开放手术（4.6% vs 6.0%）或电视胸腔镜手术（VATS）（40.2% vs 60.8%）（P < .001）。机器人方法与依从性的关联最大（vs VATS；优势比，2.53;95% CI, 2.22-2.90; P < .001）。结论楔形切除的早期NSCLC患者中，满足3+1 LNS的不到一半。接受机器人辅助的楔形切除的患者接受符合指南的LNS的可能性是前者的2.5倍。机器人方法是实现3+1 LNS的最重要因素。

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引用次数: 0

Enteral Administration of a Methylene Blue and 20% Lipid Emulsion Slurry to Aid in Diagnosis of Intraoperative Thoracic Duct Injury 术中应用亚甲蓝和20%脂质乳浆帮助诊断胸导管损伤

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.06.016

Ali Hemyari MD , Allison B. Davila MD , Michael A. Evans MD, FAAP

Thoracic duct identification during surgery in small children is often difficult or impossible secondary to patient size, surgical approach, or pathologic anatomy. Intraoperative detection of injury to the thoracic duct or other lymphatics is even more challenging, especially if the patient’s anatomy is nonstandard. We describe a congenital heart disease patient with a preexisting pleural effusion that was administered an enteral slurry of methylene blue and 20% lipid emulsion intraoperatively to help delineate anatomy and detect chyle leakage. The slurry allowed for lymphatics visualization, but not thoracic duct identification.

由于患者的体型、手术入路或病理解剖，幼儿手术中胸导管的识别通常是困难或不可能的。术中对胸导管或其他淋巴管损伤的检测更具挑战性，特别是如果患者的解剖结构不标准。我们描述了一例先天性心脏病患者，术前存在胸腔积液，术中给予亚甲基蓝和20%脂质乳剂肠内浆液，以帮助描绘解剖结构和检测乳糜漏。浆液可以显示淋巴管，但不能识别胸导管。

引用次数: 0

Double-Lung Transplant With Delayed Nuss Bar Prostheses for Pectus Excavatum Deformity 双肺移植配合延迟鼻棒假体治疗漏斗胸畸形

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.06.005

Amer Alzahrani MD, RRT , Mario Castro-Medina MD , Masashi Furukawa MD, PhD , Pablo G. Sanchez MD, PhD

Severe pectus excavatum and prior talc pleurodesis are traditionally considered relative contraindications to lung transplantation. A 36-year-old woman with idiopathic pulmonary fibrosis, pectus excavatum with a Haller Index of 6.7, and prior bilateral talc pleurodesis underwent successful bilateral lung transplantation. Chest closure was delayed due to right heart compression. On postoperative day 6, staged chest wall reconstruction with 2 Nuss bars was performed. She recovered without complications, was discharged on day 70, and remains off oxygen 910 days after transplant. With multidisciplinary planning and staged reconstruction, lung transplantation is feasible in select patients with complex chest wall pathology.

严重的漏斗胸和既往滑石性胸膜固定术传统上被认为是肺移植的相对禁忌症。一名36岁女性，特发性肺纤维化，漏斗胸，Haller指数6.7，既往双侧滑石胸膜切除术，成功接受双侧肺移植。右心受压导致胸腔闭合延迟。术后第6天，用2根Nuss棒进行分阶段胸壁重建。患者恢复无并发症，于第70天出院，移植后910天仍无氧。通过多学科规划和分阶段重建，肺移植在胸壁病理复杂的患者中是可行的。

引用次数: 0

Economic Impact of Targeted and Immunotherapies in Treating Operable Esophageal and Non-Small Cell Lung Cancers 靶向和免疫疗法治疗可手术食管癌和非小细胞肺癌的经济影响

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.01.008

Yahya Alwatari MB , Mohamed Shanshal MB , Sameh Taki Aldin MD , Nate C. Johnson PharmD, RPh , Viengneesee Thao PhD , Bijan J. Borah PhD , K. Robert Shen MD

Background

As the therapeutic landscape evolves, we aim to evaluate the cost implications of National Comprehensive Cancer Network–recommended perioperative targeted/immunotherapies for non-small cell lung cancers (NSCLCs) and esophageal cancers.

Methods

The Medicare Part B payment allowance limits of treatment were ascertained. Using published data, we estimated the annual incidence of eligible patients. We applied the estimated cost of the medication based on treatment dosing and duration. The costs per patient and incident cohort were calculated.

Results

We estimated that 8602 patients with newly diagnosed esophageal cancers would be eligible for adjuvant nivolumab. The cost to treat 1 patient was $190,000, and the cost to treat 1 incident cohort was $1.6 billion. We estimated that 50,409 patients with NSCLC will meet the criteria for neoadjuvant nivolumab with a cost of 3 cycles of $32,000 per patient and $1.7 billion per cohort. Among NSCLC patients who may undergo resection and qualify for adjuvant therapy, 70,602 patients are anticipated to be epidermal growth factor receptor–negative and treated with adjuvant atezolizumab or pembrolizumab. Treatment costs range from $178,000 to $197,000 per patient, with up to $13.9 billion cost per cohort. The cost to treat 1 patient with adjuvant osimertinib was $556,000, with an incident cohort cost of $8 billion. The cost to treat an incident cohort of eligible thoracic malignancies is estimated at $25 billion.

Conclusions

Immune and targeted therapy in operable thoracic patients is associated with a significant cost burden. Studies are needed to assess cost-effectiveness to ensure optimal resource allocation and improve patient outcomes.

背景：随着治疗领域的发展，我们旨在评估国家综合癌症网络推荐的非小细胞肺癌（nsclc）和食管癌围手术期靶向/免疫治疗的成本影响。方法确定医疗保险B部分支付补助限额。使用已发表的数据，我们估计了符合条件的患者的年发病率。我们应用了基于治疗剂量和持续时间的估计药物费用。计算每位患者和事件队列的费用。结果：我们估计有8602例新诊断的食管癌患者有资格接受nivolumab的辅助治疗。治疗1名患者的费用为19万美元，治疗1个事件队列的费用为16亿美元。我们估计50409名NSCLC患者将符合新辅助nivolumab的标准，每个患者的3个周期成本为32,000美元，每个队列的成本为17亿美元。在可能接受切除术并有资格接受辅助治疗的NSCLC患者中，预计70,602例患者为表皮生长因子受体阴性，并接受辅助atezolizumab或pembrolizumab治疗。每位患者的治疗费用从17.8万美元到19.7万美元不等，每组患者的治疗费用高达139亿美元。用辅助奥希替尼治疗1例患者的成本为55.6万美元，事件队列成本为80亿美元。治疗一组符合条件的胸部恶性肿瘤的费用估计为250亿美元。结论胸椎可手术患者的免疫和靶向治疗存在较大的费用负担。需要研究评估成本效益，以确保最佳资源分配和改善患者预后。

{"title":"Economic Impact of Targeted and Immunotherapies in Treating Operable Esophageal and Non-Small Cell Lung Cancers","authors":"Yahya Alwatari MB , Mohamed Shanshal MB , Sameh Taki Aldin MD , Nate C. Johnson PharmD, RPh , Viengneesee Thao PhD , Bijan J. Borah PhD , K. Robert Shen MD","doi":"10.1016/j.atssr.2025.01.008","DOIUrl":"10.1016/j.atssr.2025.01.008","url":null,"abstract":"<div><h3>Background</h3><div>As the therapeutic landscape evolves, we aim to evaluate the cost implications of National Comprehensive Cancer Network–recommended perioperative targeted/immunotherapies for non-small cell lung cancers (NSCLCs) and esophageal cancers.</div></div><div><h3>Methods</h3><div>The Medicare Part B payment allowance limits of treatment were ascertained. Using published data, we estimated the annual incidence of eligible patients. We applied the estimated cost of the medication based on treatment dosing and duration. The costs per patient and incident cohort were calculated.</div></div><div><h3>Results</h3><div>We estimated that 8602 patients with newly diagnosed esophageal cancers would be eligible for adjuvant nivolumab. The cost to treat 1 patient was $190,000, and the cost to treat 1 incident cohort was $1.6 billion. We estimated that 50,409 patients with NSCLC will meet the criteria for neoadjuvant nivolumab with a cost of 3 cycles of $32,000 per patient and $1.7 billion per cohort. Among NSCLC patients who may undergo resection and qualify for adjuvant therapy, 70,602 patients are anticipated to be epidermal growth factor receptor–negative and treated with adjuvant atezolizumab or pembrolizumab. Treatment costs range from $178,000 to $197,000 per patient, with up to $13.9 billion cost per cohort. The cost to treat 1 patient with adjuvant osimertinib was $556,000, with an incident cohort cost of $8 billion. The cost to treat an incident cohort of eligible thoracic malignancies is estimated at $25 billion.</div></div><div><h3>Conclusions</h3><div>Immune and targeted therapy in operable thoracic patients is associated with a significant cost burden. Studies are needed to assess cost-effectiveness to ensure optimal resource allocation and improve patient outcomes.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1129-1134"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Training of Tube Thoracostomy on Soft-Embalmed Cadavers According to Thiel and Dodge: What Do Experts Say? 根据Thiel和Dodge对软防腐尸体进行管式开胸术训练：专家怎么说？

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.07.009

Dariya Jaeger MD , Eric Hinrichs BBA , Volkan Kösek MD , Burkhard Thiel MD , Ludger Hillejan MD , Morris Beshay MD , Ralf Schoppe HE , Sven Schumann MD, PhD , Gebhard Reiss MD, PhD , Georg Feigl MD, PhD , Bassam Redwan MD, PhD

Background

Tube thoracostomy is one of the most important invasive procedures performed in many medical specialties for various indications.

Methods

A total of 13 experienced thoracic surgeons were asked to perform a single tube thoracostomy as a Bülau drain on a soft-embalmed human cadaver. The surgeons used a structured questionnaire with a modified Likert scale to rate the closeness to reality of the performed training on soft-preserved cadavers compared with standard performance on living patients. Two forms of soft embalming were available: Thiel’s, in 2 cadavers; and Dodge’s, in 2 cadavers. Six surgeons performed the procedure on Thiel embalmed cadavers, and the other 7 surgeons performed the procedure on Dodge embalmed cadavers.

Results

The evaluation of the results showed a high degree of closeness to reality and a 100% recommendation rate of the training for both forms of preservation. No significant differences could be found between Dodge embalmed cadavers and Thiel embalmed cadavers.

Conclusions

The use of soft-embalmed cadavers was rated very positively by experienced thoracic surgeons while performing tube thoracostomy. The evaluation results showed a high degree of realism of both embalming methods compared with performing the procedure on live patients. Further studies are needed to perform a competitive statistical analysis comparing Dodge embalmed cadavers and Thiel embalmed cadavers.

背景：导管开胸术是许多医学专科针对各种适应症进行的最重要的侵入性手术之一。方法请13名经验丰富的胸外科医生对一具软防腐尸体进行单管开胸引流术。外科医生使用了一份带有修改过的李克特量表的结构化问卷来评估在软保存尸体上进行的训练与在活着的病人上进行的标准训练的接近程度。软防腐有两种形式：Thiel的，在两具尸体上；道奇的，两具尸体。6名外科医生在Thiel防腐尸体上进行了手术，另外7名外科医生在Dodge防腐尸体上进行了手术。结果评价结果与实际情况接近程度高，两种保存形式的训练推荐率均为100%。Dodge防腐尸体和Thiel防腐尸体之间没有显著差异。结论经验丰富的胸外科医生在进行管式开胸手术时，对尸体进行软防腐处理的效果评价很高。评估结果显示，与对活体患者进行处理相比，这两种防腐方法具有很高的现实性。需要进一步的研究来对道奇防腐尸体和泰尔防腐尸体进行竞争性的统计分析。

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引用次数: 0

A Novel Case of Intramyocardial Ventricular Septal Defect With Surgical Implications 心内室间隔缺损一例新病例及其外科意义

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.06.002

Katherine Rand MD , Demetrios Mallios MD , Pierre Wong MD

An infant with an unrepaired ventricular septal defect (VSD) was found postmortem to have a unique VSD with anatomic features not previously described. Originally diagnosed as a perimembranous defect, autopsy revealed a tunnel-like channel with left ventricular origin inferior to the right coronary cusp, anterior to an intact membranous septum; an intramyocardial course posteroinferior to the pulmonary valve; and multiple right ventricular exit points superior to the anterior leaflet of the tricuspid valve. Accurate preoperative diagnosis is critical to guide surgical approach to this type of defect, which we term an intramyocardial VSD.

一个婴儿与未修复的室间隔缺损（VSD）被发现有一个独特的室间隔缺损解剖特征以前没有描述过。最初诊断为膜周缺损，尸检发现一个隧道状通道，起源于左心室，位于右冠状动脉尖的下方，位于完整的膜隔的前面；在肺动脉瓣后下方的心内通道；在三尖瓣前叶上方有多个右心室出口点。准确的术前诊断对于指导手术治疗这种类型的缺陷至关重要，我们称之为心肌内室间隔缺损。

引用次数: 0

HeartMate 6 in a Total Artificial Heart Configuration After Total Cardiectomy for Cardiac Sarcoma 心脏肉瘤全心切除术后全人工心脏构型中的心脏伴侣6

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.06.008

Hrvoje Gasparovic MD, PhD , Maja Cikes MD, PhD , Kristina Krželj MD , Ivo Planinc MD, PhD , Maja Hrabak Paar MD, PhD

We present the case of a 34-year-old patient with an unresectable cardiac sarcoma who underwent a total cardiectomy followed by implantation of 2 HeartMate 3 devices in a total artificial heart configuration. Surgical treatment of cardiac sarcomas ranges from palliative debulking to heart transplantation. In contrast to conventional total artificial heart placement, complete removal of both atrioventricular connections was mandated by the underlying pathologic process. Hemodynamic performance of 2 continuous flow pumps in the absence of native atria and the heart reservoir function depends on balancing preload, afterload, and individual pump rotations. The unreliability of conventional monitoring parameters in this clinical scenario makes hemodynamic management challenging.

我们报告一例34岁的心脏肉瘤患者，他接受了全心切除术，并在全人工心脏配置中植入了2个HeartMate 3装置。心脏肉瘤的手术治疗范围从姑息性减容到心脏移植。与传统的全人工心脏放置相比，完全去除房室连接是由潜在的病理过程决定的。在没有天然心房和心脏蓄水池功能的情况下，2个连续血流泵的血流动力学性能取决于平衡前负荷、后负荷和单个泵的旋转。在这种临床情况下，常规监测参数的不可靠性使血流动力学管理具有挑战性。

引用次数: 0

Efficacy of Right S2 and Left S1+2 Segmentectomy: Comparison of Pulmonary Function With Lobectomy 右侧S2和左侧S1+2节段切除术的疗效：肺功能与肺叶切除术的比较

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.06.011

Sanae Kuroda MD , Nahoko Shimizu MD, PhD , Megumi Nishikubo MD , Yuki Nishioka MD , Wataru Nishio MD, PhD

Background

Residual lobar shifting after lobectomy promotes effective lung expansion and occasionally better-than-expected preservation of pulmonary function. Our previous study found that patients with lobar shifting (shift group) exhibited considerably better preservation of forced expiratory volume in 1 second (FEV₁) than those without it (nonshift group). During left upper lobectomy, however, no significant difference in FEV₁ preservation was noted between the groups, although our results tended to favor the nonshift group. Although segmentectomy is generally better at preserving pulmonary function than lobectomy, lobar shifting after lobectomy may alter outcomes. This study aimed to identify which segmentectomy sites better preserve pulmonary function compared with lobectomy while considering lobar shifting.

Methods

We analyzed 324 segmentectomies and 839 lobectomies from 2012 to 2024, excluding middle lobe resections. Lobar shifting, evaluated using 3-dimensional computed tomography 6 months after surgery, was categorized based on middle lobe, lingular, and left lower lobe bronchus displacement. Pulmonary function tests were conducted before and 6 months after surgery. FEV₁, vital capacity, and forced vital capacity preservation rates between the segmentectomy and shift or nonshift groups were compared according to resection site.

Results

Significant differences in FEV₁ preservation between lobectomy and segmentectomy were observed only for right S2 (P < .001) and left S1 + 2 (P = .002), with both regions also showing significant differences in vital capacity and forced vital capacity.

Conclusions

Even under conditions favorable for preserving pulmonary function after lobectomy considering lobar shifting, segmentectomy of right S2 and left S1+2 resulted in better postoperative function.

背景：肺叶切除术后残留的肺叶移位可促进有效的肺扩张，偶尔也能更好地保存肺功能。我们之前的研究发现，有肺叶移位的患者（移位组）比没有肺叶移位的患者（非移位组）在1秒用力呼气量（FEV1）的保存上表现得更好。然而，在左上肺叶切除术期间，两组之间FEV1保存没有显著差异，尽管我们的结果倾向于非移位组。虽然肺节段切除术通常比肺叶切除术更能保护肺功能，但肺叶切除术后肺叶移位可能会改变预后。本研究旨在确定在考虑肺叶移位的情况下，与肺叶切除术相比，哪个节段切除术部位能更好地保护肺功能。方法分析2012年至2024年324例肺段切除术和839例肺叶切除术，不包括中肺叶切除术。术后6个月用三维计算机断层扫描评估大叶移位，根据中叶、舌叶和左下叶支气管移位进行分类。术前和术后6个月分别进行肺功能检查。根据切除部位比较节段切除术和移位或非移位组的FEV1、肺活量和强制肺活量保持率。结果肺叶切除术和节段切除术仅右侧S2 （P < .001）和左侧S1 + 2 （P = .002）的FEV1保存差异有统计学意义，肺活量和强迫肺活量在两个区域也有统计学意义。结论在考虑肺叶移位的条件下，切除右侧S2和左侧S1+2节段有利于保留肺叶术后功能。

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引用次数: 0