| ObjectiveVideo-assisted thoracoscopic surgery(Video-assisted thoracoscopic Surgery,VATS)is widely used in early non-small cell lung cancer(non-small cell lung cancer,NSCLC)patients,However,in patients with nsclc undergoing pleural lobectomy,is it necessary to retain pulmonary ligaments and simplify surgical procedures to reduce human injuries during surgery,The study still lacked data on prospective randomized controlled trials(randomized controlled trial,RCT),In this study,the clinical effect of loosening and retaining lower pulmonary ligament during thoracoscopic lobectomy in NSCLC patients was compared and analyzed.It provides a basis for whether the pulmonary ligament is loosened by endoscopic pulmonary lobectomy in NSCLC patients.Materials and methodsClinical and follow-up data of 90 patients with NSCLC who underwent video-assisted upper lobectomy from July 2017 to December 2018 in Huaihe Hospital of Henan University were collected.According to the random number table and the patient’s admission time,they were divided into two groups: lower lung ligament loosening group(group A)and preservation lower lung ligament group(group B).The pain score(VAS score)within 1 week after(ml),and the postoperative drainage(ml),chest tube indwelling time(h),)were compared between the two groups during the operation time of(min),and intraoperative bleeding volume during the first week of operation(VAS score),and the bronchi angle of the operation side was changed 1 month after operation.One month after operation,the angle of contralateral bronchus was changed,(d),was hospitalized after operation,and postoperative complications(re-catheterization,pulmonary leakage,lung infection,residual cavity rate,Incidence of lung residual cavity,atelectasis,arrhythmia)were performed.Results SPSS19.was used.0 the clinical data and follow-up data of one month after operation were analyzed by statistical software.T-test was used for the measurement data conforming to the normal distribution,and rank sum test(Mann-Whitney-U test)was used for the measurement data which did not accord with the normal distribution.The counting data were tested by χ2 test,and the continuous variable data were analyzed by single factor repeated measurement of variance.The difference was statistically significant in terms of P < 0.05.Results(1)operative time [(193.82 ±53.71)min VS.(209.15 ±53.91)min,P=0.290] and intraoperative bleeding volume [(147.05 ±50.41)ml VS.(165.38 ±53.99)ml,p=0.101].The retention time of the upper thoracic tube [(5.41 ±2.66)d VS.(5.31 ±2.04)days,P=0.840] and the retention time of the pig tail tube [(3.94 ±1.78)d VS.(3.46 ±2.23)days,P=0.260],The postoperative drainage volume [(1542.58 ±1561.34)ml VS.(1335.15 ±799.13)ml,p=0.451)] and the Length of hospital stay after left superior lobectomy [(8.86 ±3.57)d VS.(12.00 ±4.83)days,P=0.250].Length of hospital stay after right superior lobectomy [(10.10 ±3.03)d VS.(10.86 ±2.97 days,P = 0.250],change in the angle of the right bronchus one month after the right superior lobectomy [(6.04 ±4.40)°vs(7.69 ±5.96)°].Changes in the Angle of the contralateral bronchus after right superior lobectomy [(-6.37 ±8.43)°VS.(-5.96 ±4.53)°,P=0.841],Changes in the Angle of the left bronchus after left superior lobectomy [(9.03 ±8.64)°vs(19.41 ±4.68)°,P=0.000],Changes in the Angle of the contralateral bronchus after left superior lobectomy [(-1.13 ±8.87)°VS.(-1.64 ±9.10)°,P=0.858];Postoperative complications: re-catheterization(3 cases VS.6 cases,p=0.114),pulmonary leakage [(6 cases VS 6 cases),p=0.718],atelectasis [(3 cases VS.0 cases),p=0.123],pulmonary infection [(9 cases VS 12 cases,P=0.145)],Incidence of left lung residual cavity on the second day after operation [(6 cases VS.15 cases),p=0 001],Incidence of right lung residual cavity on the second day after operation(21 cases VS.12,p =0.344),Incidence of left lung residual cavity 1 month after operation [(0 cases VS 6 cases,p=0.004)],the left right remnant lumen of 1 month postoperatively [(6 cases VS 3 cases,p =0.598)],left residual cavity rate on the second day after surgery(7.45 ±14.01)VS.(22.50 ±13.13),P=0.001),right residual cavity rate on the second day after surgery [(10.71 ±10.98)VS.(10.16 ±9.71),P =0.852],left residual cavity rate 1 month after surgery [(0.00 ±0.00)VS.(8.57 ±12.51),P=0.003],right residual cavity rate 1 month after surgery [(2.38 ±4.98)VS.(2.68 ±6.72),P=0.856],arrhythmia [0 cases VS 0 cases constant].Compared with patients in group A and group B,There were statistically significant differences in the Angle of the left bronchus after left superior lobectomy,and postoperative hospital stay,and the incidence of left lung residual cavity 2 days and 1 month after surgery,and residual cavity rate of left lung residual cavity 2 days and 1 month after surgery(P<0.05).The time of operation,intraoperative bleeding volume,the retention time of the upper thoracic tube,the retention time of the pig tail tube,the angle of the right bronchus and the contralateral bronchus 1 month after the operation were changed.the angle of the right bronchus and postoperative complications(pulmonary leakage,pulmonary infection,re-catheterization,atelectasis and arrhythmia)1 month after left lung operation(P > 0.05),and there was no significant difference between the two groups(P > 0.05).There was no significant difference in pain score between group A and group B within 1 week after operation(P > 0.05).(2)there were 110 cases in pre-operation group(55 cases in group A,55 cases in group B),20 cases were removed after operation,including 4 cases in group A(pulmonary wedge resection in 1 case,combined lobectomy in 1 case,non-NSCLC in 2 cases).There were 15 cases in group B(pulmonary wedge resection in 2 cases,combined lobectomy in 2 cases,pulmonary segmental resection in 2 cases,postoperative pathology in 9 cases),shedding in 1 case(1 case in group B had not been re-diagnosed one month after operation),A total of 90 cases were followed up(51 cases in group A,39 cases in group B).The total follow-up rate was 81.18%,and there was no death due to disease during the follow-up period in both groups.(3)there were 3 cases of right pulmonary atelectasis,including 2 cases of atelectasis of right middle lobe and 1 cases of right middle lobe and inferior lobe atelectasis after thoracoscopic right upper lobectomy.The difference was statistically significant.Conclusion(1)during thoracoscopic left upper lobectomy,the release of inferior pulmonary ligament could shorten the hospitalization time,reduce the rate of residual cavity and the incidence of residual cavity,and The left bronchial angle change loosening group has less change than that of retaining inferior pulmonary ligament.It is suggested that the lower lung ligaments be loosened during thoracoscopic left superior lobectomy to reduce complications and promote postoperative recovery.(2)the incidence of atelectasis in the middle / lower lobe of the right lung was increased when the ligaments of the lower lung were loosened by thoracoscopic resection of the upper lobe of the right lung.May be due to loosening the lower ligament of the lungs may cause bronchial distortion,resulting in residual lung lobe atelectasis.Therefore,it is suggested that the lower lung ligament should be preserved when the right superior lobectomy is performed. |
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