能量器械马蹄铁形段间平面处理方法在肺部结节胸腔镜精准肺段切除术中的应用

汪方清; 陈刚; 阮卫民; 胡卫建; 陈胜; 李胜平; 汪金钱

doi:10.16766/j.cnki.issn.1674-4152.002722

能量器械马蹄铁形段间平面处理方法在肺部结节胸腔镜精准肺段切除术中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002722

铜陵市人民医院心胸外科一病区，安徽铜陵 244000

基金项目:

皖南医学院教学医院科研专项项目 JXYY202211

安徽省重点研究与开发计划项目 202104j07020 003

铜陵市卫生健康委员会科学研究基金项目卫科研[2019]1号

详细信息

通讯作者:
汪方清, E-mail: 1307855229@qq.com

中图分类号: R655.3 R734.2
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出版历程
- 收稿日期: 2021-10-25
- 网络出版日期: 2022-12-30

The application of horseshoe-shaped intersegmental plane processing method with energy equipment in thoracoscopic accurate pulmonary nodules segmentectomy

Ward 1, Department of Thoracic Surgery, Tongling People ' s Hospital, Tongling, Anhui 244000, China

摘要

摘要: 目的探讨能量器械马蹄铁形段间平面处理方法应用于肺部结节胸腔镜精准肺段切除术的有效性与安全性。方法选择2019年1月—2021年6月因肺部结节在铜陵市人民医院行胸腔镜下肺段切除手术的100例患者，采用随机数字表法分为能量器械马蹄铁形段间平面切开组(观察组)和切缝器段间平面切开组(对照组)，各50例，对比分析手术前后相关临床资料。主要观察指标为术后3 d内引流量、术后肺漏气时间、动脉血气和肺功能等。结果 2组术中出血量、手术时间、术后3 d内引流量、术后引流管留置时间、术后肺漏气时间、术后住院时间、术后并发症等指标比较差异无统计学意义(均P>0.05)；观察组住院费用少于对照组(P < 0.001)；术后1个月观察组动脉血气和肺功能指标显著优于对照组(均P < 0.05)，观察组术后PaO₂大于对照组，术后PaCO₂小于对照组，观察组术后用力肺活量为(2.58±0.43)L，高于对照组的(2.21±0.34)L，观察组术后第1秒用力呼气容积为(2.32±0.39)L，高于对照组的(1.96±0.32)L，差异有统计学意义(均P < 0.05)。结论能量器械马蹄铁形段间平面处理方法应用于肺部结节精准肺段切除术，是一种安全、有效、肺膨胀更加良好并能节约高值耗材的方法，值得推广。
- 能量器械 /
- 马蹄铁形段间平面处理方法 /
- 肺结节 /
- 肺段切除术
Abstract: Objective To explore the effectiveness and safety of the application of horseshoe-shaped intersegmental plane processing method with energy equipment in thoracoscopic accurate pulmonary nodules segmentectomy. Methods Total 100 patients underwent thoracoscopic segmentectomy for the treatment of pulmonary nodules in Tongling People ' s Hospital from January 2019 to June 2021 were randomly divided into horseshoe-shaped intersegmental plane incision group with energy equipment (observation group) and intersegmental plane incision group with cutting suture device (control group) according to the random digital table method, with 50 cases in each group. The preoperative and postoperative clinical data was compared and analyzed. The main indexes included the drainage volume within 3 days after operation, the time of pulmonary leakage, arterial blood gas and pulmonary function. Results There was no difference in indexes like intraoperative blood loss, operation time, postoperative drainage volume within 3 days, postoperative drainage tube indwelling time, postoperative pulmonary air leakage time, postoperative hospitalization time and postoperative complications between the two groups (all P>0.05). Hospitalization costs in the observation group were significantly less than those in the control group (P < 0.001). At 1 month after operation, the arterial blood gas and the pulmonary function of the observation group was significantly better than that of the control group (all P < 0.05). The postoperative PaO₂ in the observation group was higher than that of the control group, the postoperative PaCO₂ in the observation group was lower than that of the control group, the postoperative forced vital capacity in the observation group [(2.58±0.43) L] was higher than that of the control group [(2.21±0.34) L], and the postoperative forced expiratory volume in one second in the observation group [(2.32±0.39) L] was higher that of the control group [(1.96±0.32) L]. The differences were statistically significant (all P < 0.05). Conclusion The application of horseshoe-shaped intersegmental plane processing method with energy equipment in thoracoscopic accurate pulmonary nodules segmentectomy is a safe and effective method with better pulmonary expansion and high-value consumables saving, which is worth popularizing.
- Energy equipment /
- Horseshoe-shaped intersegmental plane processing method /
- Pulmonary nodules /
- Segmentectomy

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图 1 观察组马蹄铁形切开段间平面

Figure 1. Divided into the horseshoe-shaped intersegmental plane in the observation group

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图 2 观察组马蹄铁形段间平面

Figure 2. Horseshoe shaped intersegmental plane in the observation group

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表 1 2组肺部结节患者一般资料比较

Table 1. Comparison of general data between two groups

组别	例数	性别(例)		年龄(x±s，岁)	BMI (x±s)	术中病理(例)
组别	例数	男性	女性	年龄(x±s，岁)	BMI (x±s)	良性	AIS/MIA
观察组	50	19	31	57.12±12.26	23.32±1.82	5	45
对照组	50	24	26	57.90±12.67	23.36±1.86	7	43
统计量		1.020^a		0.313^b	0.109^b	0.379^a
P值		0.313		0.755	0.913	0.538
注：^a为χ²值，^b为t值。AIS为原位腺癌(adenocarcinoma in situ)，MIA为微浸润腺癌(minimally invasive adenocarcinoma)。

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表 2 2组肺部结节患者肺结节所属肺段分布情况比较(例)

Table 2. Comparison of lung segment distribution of pulmonary nodules between two groups (cases)

组别	例数	右上叶				右下叶				左上叶				左下叶
组别	例数	S1	S2	S3	小计	S6	S7+8	S9+10	小计	S1+2	S3	S4+5	小计	S6	S7+8	S9+10	小计
观察组	50	13	6	4	23	3	1	1	5	9	2	4	15	4	2	1	7
对照组	50	10	5	4	19	4	3	1	8	7	3	7	17	4	1	1	6
χ²值					0.657				0.796				0.184				0.048
P值					0.418				0.372				0.668				0.827

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表 3 2组肺部结节患者手术相关资料比较(x±s)

Table 3. Comparison of surgical data between two groups (x±s)

组别	例数	术中出血量(mL)	手术时间(min)	术后3 d总引流量(mL)	引流管留置时间(d)	术后漏气时间(d)	术后住院时间(d)	住院费用(元)
观察组	50	74.41±22.72	116.57±19.56	339.92±71.83	2.85±1.21	1.95±1.33	4.42±0.90	20 755.26±3 438.65
对照组	50	68.92±20.15	108.53±22.36	314.81±57.21	2.79±0.97	1.70±0.90	4.25±1.13	24 613.21±5 493.36
t值		1.278	1.913	1.934	0.274	1.100	0.832	4.209
P值		0.204	0.059	0.056	0.785	0.274	0.407	< 0.001

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表 4 2组肺部结节患者动脉血气和肺功能指标比较(x±s)

Table 4. Comparison of arterial blood gas and pulmonary function indexes between two groups (x±s)

组别	例数	PaO₂(mm Hg)		PaCO₂(mm Hg)		FVC(L)		FEV₁(L)
组别	例数	术前	术后	术前	术后	术前	术后	术前	术后
观察组	50	85.3±11.4	76.7±17.6^a	40.5±3.4	31.3±9.4^a	2.84±0.35	2.58±0.43^a	2.63±0.41	2.32±0.39^a
对照组	50	83.2±10.5	69.3±12.3^a	41.3±2.8	36.1±10.2^a	2.79±0.36	2.21±0.34^a	2.65±0.30	1.96±0.32^a
t值		0.958	2.437	1.284	2.450	0.704	4.772	0.278	5.046
P值		0.340	0.017	0.202	0.016	0.483	< 0.001	0.782	< 0.001
注：与同组术前比较，^aP < 0.05。1 mm Hg=0.133 kPa。

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