| Objective: To analyze postoperative lung volume changes in non-small cell lung cancer(NSCLC)patients undergoing video-assisted thoracoscopic surgery(VATS)using three-dimensional reconstruction lung volume measurement,and to investigate the influencing factors of lung volume compensation after pneumonectomy.Methods: A total of 51 patients who underwent thoracoscopic lobectomy or anatomical segmentectomy for primary lung cancer at the Second Thoracic Surgery Department of Shengjing Hospital of China Medical University between January 2021 and December2021 were included in this study,and the patients were divided into lobectomy and segmentectomy groups according to the surgical procedure,with 28 patients in the lobectomy group and 23 patients in the segmentectomy group.All patients underwent pulmonary function tests and chest enhancement/high-resolution CT within one week before surgery(T0)and underwent chest CT again at 3 months(T1),6 months(T2),and12 months(T3)after surgery,respectively.Clinical and imaging data were collected prospectively from patients,including age,gender,BMI,smoking status,underlying preoperative disease,postoperative pulmonary complications and preoperative pulmonary function indices,surgical site and chest CT images.Univariate analysis was performed on the differences between the clinical data,preoperative pulmonary function indicators,preoperative and postoperative total lung volume,postoperative lung volume growth rate and growth ratio between the two groups;The Pearson method was used to correlate the preoperative lung volume with the preoperative pulmonary function test indexes;Factors such as gender,age,BMI,smoking history and the percentage of surgically removed lung volume in total lung volume(hereinafter referred to as the percentage of lung volume loss)were listed as independent variables,and the degree of lung volume compensation was listed as dependent variables for binary Logistic regression analysis.The above statistical results were considered statistically significant at P < 0.05.Results:(1)There were no statistically significant differences between the thoracoscopic lobectomy group and the segmentectomy group in gender,age,smoking history,BMI,preoperative underlying diseases,postoperative lung complications,and preoperative pulmonary function test indexes(FVC,FEV1,FEV1/FVC,and MVV)between the two groups(P > 0.05).(2)The proportion of the same lung lobe in the total lung volume varies significantly among different individuals.In all the cases observed in this study,the maximum and minimum proportions of the right upper lobe in the total lung volume are 27.37% vs.14.48%,the middle lobe of the right lung is 13.63% vs.4.92%,and the lower lobe of the right lung is 29.06% vs.15.90%.The upper lobe of left lung was28.95% vs.18.81%,and the lower lobe of left lung was 27.45% vs.13.72%.(3)Preoperative total lung volume was positively correlated with preoperative PFT indexes FVC and FEV1 in both groups(correlation coefficient r ranged from 0.509-0.607,P <0.05).(4)The lung volume loss in lobectomy group was significantly higher than that in segmentectomy group(938.94 ± 261.05 m L vs.346.01 ± 145.44 m L,P < 0.05).There was no significant difference in the whole lung volume between the two groups preoperative,3 months after operation,6 months after operation and 12 months after operation(P > 0.05).There was also no statistical significance in total lung volume among all groups at different time(P > 0.05).(5)The rate of lung volume recovery in both groups was higher at 3-6 months after surgery than at 6-12 months after surgery.Lobectomy group(58.10 ± 18.09 m L/m vs.16.91 ± 5.54 m L/m,P < 0.05).Segmentectomy group(38.93 ± 31.66 m L/m vs.9.59 ± 8.65 m L/m,P < 0.05);The growth ratio of postoperative lung volume in both groups was also higher at 3-6 months after surgery than at 6-12 months after surgery: lobectomy group was(4.62 ± 1.60% vs.2.69 ± 1.29%,P < 0.05),segment resection group was(2.98 ± 1.45% vs.1.45 ± 1.26%,P< 0.05).In each time period,the growth ratio of lung volume in lobectomy group was higher than that in segmentectomy group(P < 0.05).(6)In the single factor Logistic regression analysis,age and the proportion of lung volume loss were important factors affecting lung volume compensation after lung resection.Further multivariate Logistic regression analysis of the above variables showed that young age [P < 0.05,OR = 10.015(95%CI : 1.107-68.047)],the proportion of high lung volume loss [P < 0.05,OR =1.208(95%CI : 1.061-1.490)] was positively correlated with the degree of lung volume compensation after surgery.Conclusion:(1)The preoperative lung volume obtained by three-dimensional reconstruction lung volume measurement has a good correlation with the preoperative lung function test indexes FEV1 and FVC.This method is simple and has no extra cost,so it is suitable for lung function evaluation in combination with lung function examination.(2)After pneumonectomy,the lung volume recovered at a uniform speed,and the growth rate and growth rate of lung volume decreased gradually with time.(3)The loss of lung volume after pneumonectomy will be compensated.Age and the proportion of lung volume loss are important factors affecting postoperative lung volume compensation.Younger age and higher proportion of lung volume loss are positively correlated with the degree of postoperative lung volume compensation. |
PDF Full Text Request