直线切割缝合器牵引装置在肺段切除术中离断段支气管的单中心回顾性队列研究  

The benefits of stapler tractor dissociating segmental bronchus in lung segmentectomy:A retrospective cohort study in a single center

作　　者：张斌[1] 郑佳男 陈亮 朱全 朱健 闻伟 ZHANG Bin;ZHENG Jianan;CHEN Liang;ZHU Quan;ZHU Jian;WEN Wei(Department of Thoracic Surgery,Jurong Hospital Affiliated to Jiangsu University,Zhenjiang,242400,Jiangsu,P.R.China;Department of Thoracic Surgery,The First Affiliated Hospital of Nanjing Medical University,Nanjing,210029,P.R.China;Department of Thoracic and Cardiovascular Surgery,General Hospital of Central Theater Command of the People's Liberation Army,Wuhan,430070,P.R.China)

机构地区：[1]江苏大学附属句容医院胸外科,江苏镇江242400 [2]南京医科大学第一附属医院(江苏省人民医院)胸外科,南京210029 [3]中国人民解放军中部战区总医院心胸外科,武汉430070

出　　处：《中国胸心血管外科临床杂志》2024年第10期1434-1441,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金面上项目(61971118);中国人民解放军中部战区总医院“三英一队”人才工程项目(2023-1692)。

摘　　要：目的分析直线切割缝合器牵引装置应用于肺段切除术中处理段支气管的可能获益。方法回顾性分析2020年11月—2023年8月南京医科大学第一附属医院胸外科同一手术团队收治的肺段切除术患者的临床数据和手术全程视频。将病例资料完整的患者分为段支气管离断处理使用直线切割缝合器牵引装置组(A组)、段支气管牵引组(B组)、段支气管离断处理直接使用直线切割缝合器组(C组)、段支气管离断处理使用丝线结扎组(D组)。比较各组的基线资料和录像回放的手术细节。手术细节包括一次成功游离并切断段支气管的比例、成功游离并切断段支气管所用时间、游离段支气管过程中出血发生率、术中转开胸率、手术结果(总手术时间、术后住院时间、术后胸腔引流量、肺漏气率等)。结果共纳入患者325例,其中A组203例、B组62例、C组29例、D组31例。4组患者基线资料差异无统计学意义。4组患者总手术时间、术后住院时间、术中出血量、段支气管残端长度、术后肺漏气率、段支气管处理时出血率、手术中转开胸率差异均有统计学意义(P<0.05)。结论直线切割缝合器牵引装置在肺段切除术中处理段支气管可缩短手术时间、降低手术中出血风险、减少手术并发症。录像回放手术细节有助于评价和提高肺段切除手术质量。Objective To investigate the benefits of using a stapler tractor in the treatment of segmental bronchus during lung segmentectomy through detailed video replay analysis of surgical procedures.Methods We collected data from patients who underwent segmentectomy performed by the same surgical team in the Department of Thoracic Surgery,the First Affiliated Hospital of Nanjing Medical University,from November 2020 to August 2023.After excluding data that lacked analysis parameters,the remaining patients were divided into four groups based on the methods used for dissociating segmental bronchus:a stapler tractor group(group A),a stapler with bronchial stretching group(group B),a stapler only group(group C),and a silk ligature group(group D).Then,we compared baseline data and videotaped surgical details across all groups.Surgical details included the success rate of one-time segmental bronchus dissociation and severance,the time taken for successful one-time dissociation and severance of the segmental bronchus,the incidence of bleeding during bronchus dissociation,the conversion rate to thoracotomy during surgery,and surgical outcomes such as total operative time,postoperative hospitalization days,postoperative thoracic drainage volume,and pulmonary air leakage rate.Results The study included 325 patients(203 in the group A,62 in the group B,29 in the group C,and 31 in the group D).There was no statistically significant difference in baseline data among the four groups.However,significant differences were found in terms of total operation time,postoperative hospitalization days,intraoperative blood loss,segmental bronchial stump length,postoperative air leakage rate,hemorrhage rate during segmental bronchial dissociation,and conversion to thoracotomy rate among the four groups(P<0.05).Conclusion Using a stapler tractor for dissociating segmental bronchus in lung segmentectomy results in shorter operative time,less risk of intraoperative bleeding,and less surgical complications.This study provides valuable evaluation met

关 键 词：肺段切除手术 手术技巧 直线切割缝合器 扁管型引导装置 手术质量评价 手术录像回放 

分 类 号：R734.2[医药卫生—肿瘤]