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Dissection of lung parenchyma using electrocautery is a safe and acceptable method for anatomical sublobar resection

机译:使用电灼术切除肺实质是一种安全,可接受的解剖性肺叶下切除方法

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Background Anatomic sublobar resection is being assessed as a substitute to lobectomy for primary lung cancers. However, persistent air leak after anatomic sublobar resection is prevalent and increasing surgical morbidity and costs. The use of electrocautery is being popularized recently in anatomic sublobar resection. We have retrospectively evaluated the safety and efficacy of intersegmental plane dissection using electrocautery. Methods Between April 2009 to September 2010, 47 patients were treated with segmentectomy for clinical T1N0M0 non-small cell lung cancers. The intersegmental plane was dissected using electrocautery alone or in combination with staplers. We evaluated the methods of dividing intersegmental plane (electrocautery alone or combination with electrocautery and staplers), intraoperative blood loss, duration of chest tube placement, duration of surgery, preoperative FEV1.0?%, incidence of prolonged air leak, length of postoperative hospital stay, postoperative pulmonary function at 6 months after surgery and the cost for sealing intersegmental plane. Results Among the 47 patients, 22 patients underwent intersegmental plane dissection with electrocautery alone and 25 patients did in combination with electrocautery and staplers. The mean number of stapler cartridges used was only 1.3 in electrocautery and staplers group. Mean age, gender, number of patients whose FEV1%?
机译:背景技术解剖性大叶下切除术已被评估为可替代原发性肺癌的肺叶切除术。然而,解剖性肺叶切除术后持续的漏气是普遍的,并且增加了手术发病率和成本。电烙术的使用最近在解剖性大叶下切除术中得到普及。我们回顾性评估了使用电灼术进行节间平面解剖的安全性和有效性。方法2009年4月至2010年9月,对47例行T1N0M0非小细胞肺癌的患者行节段切除术治疗。单独使用电烙术或与吻合器相结合,对节间平面进行解剖。我们评估了分割节间平面的方法(单独进行电灼或与电灼和缝合器结合使用),术中失血,胸管放置持续时间,手术持续时间,术前FEV1.0 %%,长时间漏气的发生率,术后住院时间停留时间,术后6个月的肺功能和封闭节段平面的费用。结果47例患者中,有22例仅行电烙术进行了节间平面解剖,有25例行电烙术和吻合器缝合。在电灼和订书机组中,使用的订书钉盒的平均数量仅为1.3。两组的平均年龄,性别,FEV1%≤<70%的患者人数相似。单纯电灼与结合电灼和吻合器组的手术时间(282 vs. 290分钟),术中失血量(203 vs. 151 ml),胸管放置时间(3.2 vs. 3.1天)之间无统计学差异。 ,术后住院时间(11.0 vs. 10.0天),术后FEV1.0丢失(13 vs. 8%),FVC丢失(11 vs. 6%)或轻微的术后并发症发生率[9%(2/22)对比16%(4/25),p?=?0.30)]。但是,单独电灼组的长期漏气发生率高于电灼和吻合器组[14%(3/22)vs. 4%(1/25),p≤0.025)]。单独使用电灼治疗组,密封漏气的材料成本为每名患者964欧元,结合电灼和缝合器组,每位患者的费用为1594欧元。结论仅电灼组的漏气时间长的患者较高。除电灼外还使用订书机可以减少长时间的漏气。然而,使用电烙术进行节间平面解剖是安全的,术后并发症可以接受,并且可以有效降低成本。

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