The Discussion Of The Need To Release The Inferior Pulmonary Ligament In Uniportal Video-assisted Thoracic Surgery(VATS) For Right Upper Lobectomy

Objective: At present,malignant tumors have become an important factor that seriously threatens people’s life and health.Among the most common malignant tumors with high mortality in the world,lung cancer occupies the top position.Because there are no obvious symptoms in the early stage of lung cancer,many patients are not diagnosed until they progress to the middle and late stages.As people pay more attention to physical health and the wide popularization of high-resolution CT,more and more early lung cancer are found in daily physical examination.For early and middle stage non-small cell lung cancer,VATS lobectomy has become one of the standard treatment options,however,there is no relevant guideline for the release of inferior pulmonary ligament during VATS upper lobectomy.There are two views on this clinically,Some physicians believe that releasing the inferior pulmonary ligament during upper lobectomy can promote compensatory expansion of the remaining lung after surgery,thereby filling the residual cavity.Other doctors believe that releasing the inferior pulmonary ligament can not promote the postoperative compensatory expansion of the remaining lung,but may cause bronchial deformation,distortion and stenosis,which may lead to postoperative pulmonary function decline.The change of aerodynamics or airway sensitivity caused by bronchial tortuosity may cause the occurrence of persistent cough after operation.In recent years,persistent postoperative cough has become the most common complication after VATS,Therefore,clinicians pay more and more attention to the need to release the inferior pulmonary ligament during VATS upper lobectomy.The aim of this study is to investigate whether it is necessary to release the inferior pulmonary ligament in uniportal VATS right upper lobectomy by comparing and analyzing the short-term clinical efficacy of patients with preservation of pulmonary ligament and release of inferior pulmonary ligament in uniportal VATS right upper lobectomyMethods: Patients with lung cancer admitted to the Department of Thoracic Surgery,the Second Hospital of Dalian Medical University from January 2018 to June 2022 were selected.According to the inclusion criteria,75 patients who underwent uniportal VATS right upper lobectomy were selected.According to the order of admission time,the patients were randomly divided into the release of inferior pulmonary ligament group and the retention of inferior pulmonary ligament group according to the random number table,There were 50 cases in the release group and 25 cases in the retention group.The surgical methods of the two groups were roughly the same,only the release of the inferior pulmonary ligament was different.The cough symptom score was used to score the cough situation of patients one month after surgery.The cough at one month after surgery,operation time,intraoperative blood loss,postoperative hospital stay,total thoracic drainage volume,postoperative closed thoracic drainage tube indwelling time,number of lymph node dissection,number of lymph node dissection groups,residual cavity rate and residual cavity incidence on the second day after surgery were compared between the two groups.Results: In uniportal VATS right upper lobectomy,the preservation of the pulmonary ligament group compared with the release of the inferior pulmonary ligament group,the operation time [(91.52±16.75)min VS(98.64±24.16)min,P=0.196],Intraoperative blood loss[(19.2±10.55)ml VS(22.2±14.04)ml,P=0.355],postoperative hospital stay[(4.36±3.26)d VS(4.34±2.15)d,P=0.975],postoperative closed thoracic drainage tube indwelling time [(2.52±3.24)d VS(2.84±2.20)d,P=0.621],number of lymph node dissection [(14.12±6.15)VS(15.1±5.24),P=0.480],the rate of residual cavity on the second day after operation [(3.24±5.302)% VS(2.8±4.907)%,P=0.723],the rate of residual cavity on the second day after operation [48% VS 48%,P=1],and postoperative cough had no significant difference(P > 0.05).The number of lymph node dissection group [(6.52±0.98)group VS(7.42±0.83)group,P < 0.05] and the total amount of thoracic drainage [(952.4±691.78)ml VS(1322.7±822.71)ml,P=0.049] between the two groups were statistically significant(P < 0.05).Conclusion: It is recommended that the inferior pulmonary ligament should not be released during uniportal VATS right upper lobectomy.