| Background:At present,lung cancer is still the most malignant tumor with the highest morbidity and mortality globally,including non-small cell lung cancer(NSCLC)and small cell lung cancer(SCLC).Non-small cell lung cancer accounts for about 85%of the total number of lung cancer,early non-small cell lung cancer lesions are relatively limited,the possibility of lymph node metastasis is small,the first choice of surgical treatment.With the development of medical imaging technology,especially low dose computed tomography(LDCT)is widely used and applied,the diagnosis rate of early pulmonary disease is improved obviously,and the early diagnosis and treatment of lung cancer is more convenient.Some recent studies have shown that thoracoscopic anatomic segmentectomy for the treatment of early lung cancer has a unique advantage,it can not only achieve from the oncology and thoracoscopic lobectomy equal curative effect,can maximum limit retained more normal lung tissue and segment between patients with venous,shorten the postoperative recovery period and improve the quality of life of postoperative.However,how to accurately identify the intersegmental plane has always been one of the difficulties in thoracoscopic anatomic segmentectomy.At present,the recognized methods of recognizing intersegmental plane in the world can be divided into two categories:vascular method and bronchial method.The arterial-ligation-alone method proposed in this study is one of the vascular methods.We compared the intersegmental plane identified by arterial-ligation-alone method with the intersegmental plane identified by ligation of pulmonary arteries and bronchi to study the feasibility and superiority of our novel method".Methods:We retrospectively studied the provincial hospital affiliated to shandong university from August 2018 to September 2019 clinical diagnosis for the ?a and ?b period lung cancer TNM staging(eighth edition)in NSCLC,and proposed thoracoscopic anatomic segmentectomy.Each patient underwent preoperative three-dimensional(3D)reconstruction of lung tissue on the affected side through Hisense Computer assisted surgery system(HCAS).According to the reconstructed lung tissue.The surgeon can clearly locate the lesion and distinguish between the arteries,veins,and bronchi that target the lung segment.The experimental methods were as follows:first,all patients were given double-lumen endotracheal intubation under general anesthesia,and contralateral single-lung ventilation was performed during the operation.According to preoperative 3D reconstruction,we accurately dissociated and ligated the arteries in the lung segment where the lesion was located.Second,double lung ventilation was performed with pure oxygen to ensure that all intrathoracic operations were stopped after the lung tissue on the affected side was fully expanded.After waiting for a period of time,obvious Plane 1 would appear,and the lung surface was marked with an electric coagulation hook.Record the elapsed time(T1)waiting for the plane to appear.Thirdly,the veins and bronchi of the lung segment where the lesion was located were ligated,and double lung ventilation was performed with pure oxygen again,the method was the same as the previous step.We can obtain the Plane 2 of the second pass and the waiting time of the second pass(T2).The consistency was evaluated by measuring the maximum distance(D)between two planes.The t test(Student's t test)was used to analyze the differences in the interface time between the two waiting periods,and the differences in the age,gender,pulmonary function ventilation and dispersion indexes(FEV1%,TLCO%)and the size of nodules in the patients in the successful and failed intersegmental plane group.The above data analysis by SPSS 2.0(IBM,SPSS Statistics,Chicago,IL,USA)software analysis.Result:A total of 104 patients were enrolled in the trial,and the arterial-ligation-alone method successfully obtained clear intersegmental planes in 99(95.2%)of these patients.For all patients,the lesions were located in the right upper lobe(24cases,23.1%),right lower lobe(25cases,24.0%)the left upper lobe(40cases,38.5%),and the left lower lobe(15cases,14.4%).No lesion was located in the right middle lobe.Ultimately,85(81.7%)patients underwent thoracoscopic anatomic segmentectomy.The results for evaluating the differences between the 2 planes were as follows:completely consistent(94 cases,94.9%),basically consistent(5 cases,5.1%),and discrepant(0 cases,0%).The mean T1 was 13.6±2.7minutes(range:8-25 minutes),and the mean T2 was 13.0±2.6minutes(range:8-23 minutes),with p=0.100(95%confidence interval).The FEV1%of patients who successfully obtained the intersegmental plane was significantly higher than that of the failure group,and the difference between the two groups was statistically significant(102.7±16.37%vs 83.7±23.80%,P=0.015).In the 85patients who underwent segmentectomy,the mean margin width was 2.84±0.51cm,the mean operative duration was 165.6 ±18.3 minutes,the mean operative hemorrhage was 52.1±20.2 ml,and the mean duration of chest tube drainage was 3.9±1.3 days.Postoperative complications related to operative procedures occurred in 2 cases.Conclusion:The arterial-ligation-only method can effectively,accurately and inexpensively identify the intersegmental plane,and is especially suitable for the patients whose veins or bronchi are difficult to anatomize. |
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