| ObjectiveWorldwide,the incidence rate and mortality of lung cancer are increasing year by year.This is inextricably linked to human life style and living environment.Lung cancer,also known as primary bronchial carcinoma,is defined by the World Health Organization(WHO)as a malignant tumor originating from respiratory epithelial cells.Lung cancer can be divided into small cell lung cancer and non-small cell lung cancer according to the pathological changes of tissues.Clinically,the most common is non-small cell lung cancer.For early malignant tumors,early detection and early treatment can often achieve good results,and lung cancer is no exception.In recent years,with the rapid development of science and technology and people’s attention to physical examination,low dose computed tomography(LDCT)has been widely used in clinical applications.This also further improves the diagnosis rate of early lung disease,and also has sufficient time to treat early lung cancer.The latest retrospective study has confirmed that for early lung cancer,compared with traditional thoracoscopic assisted lobectomy,thoracoscopic assisted anatomical segmental pneumonectomy has unique advantages.On the premise of the principles of oncology,its overall survival rate is better than lobectomy,and it can maximize the preservation of more healthy lung tissue and effective protection of intersegmental veins,while patients can get better life treatment after surgery.In thoracoscopic anatomical segmental resection of the lung,the recognition of the inter-segmental plane is the most important.If the inter-segmental plane is incorrectly recognized during the operation,it may lead to residual lesions.At present,there are many methods to identify the inter-segmental plane in the world,but all of them are based on the difference of circulation or ventilation.The "selective artificial pneumothorax assisted target-arterectomy" proposed in this study is based on the principle of circulation difference.We compare the inter-segmental plane identified by the "selective artificial pneumothorax assisted target-arterectomy" with the inter-segmental plane identified by the target-segment artery,target-segment vein and target-segment bronchus to study the advantages and feasibility of the "selective artificial pneumothorax assisted target-arterectomy".MethodsA retrospective analysis was made of 60 patients with non-small cell lung cancer diagnosed as stage Ia and stage Ib who were admitted to the Department of Thoracic Surgery of the Affiliated Hospital of Yangzhou University(West District)from June 1,2021 to June 30,2022,and were scheduled to undergo anatomical segmental resection of the lung.They were divided into control group(30 cases)and experimental group(30cases).The control group was treated with "improved dilation and collapse method",and the experimental group was treated with "selective artificial pneumothorax assisted target artery resection method".The age,sex,lung ventilation function,length of hospital stay,operation time,time of thoracic tube removal,time of inter-segmental plane formation,tumor diameter and other differences were compared.The above data were analyzed by SPSS26.0(IBM,SPSS Statistics,Chicago,IL,USA)software.Results(1)Preoperative basic data: There was no statistical difference between the two groups in age,sex,smoking history,preoperative pulmonary ventilation function,preoperative pulmonary diffusion function,etc(2)Length of hospitalization: the average length of hospitalization in the control group was 8.97 ± 1.65 days,and the average length of hospitalization in the experimental group was 7.93 ± 1.05 days,P=0.005.There was a statistical difference between the two groups.The length of hospitalization in the experimental group was shorter than that in the control group.(3)Intersegmental plane formation time: the average intersegmental plane formation time in the control group was 13.73 ± 1.76 minutes,and the average intersegmental plane formation time in the experimental group was 7.20 ± 1.47 minutes.P<0.001,with statistical difference.The formation time of inter-segmental plane in the experimental group was shorter than that in the control group.(4)Intraoperative bleeding volume: the average intraoperative bleeding volume in the control group was 67.67 ± 28.61 ml,and the average intersegmental plane formation time in the experimental group was 52.67 ± 22.43 ml.P=0.028,with statistical difference.The amount of intraoperative bleeding in the experimental group was less than that in the control group.(5)The average tumor diameter in the control group was 1.21 ± 0.33 cm.The average tumor diameter in the experimental group was 1.24 ± 0.29 cm.P=0.74,there was no significant difference between the two groups.(6)Distance from tumor to the cutting edge: the average distance from the tumor to the cutting edge in the control group was 2.88 ± 0.58 cm,and the average distance from the tumor to the cutting edge in the experimental group was 2.85 ± 0.62 cm.P=0.83,there was no significant difference between the two groups.(7)Operation time: the average operation time in the control group was 143.87 ±24.71 minutes,and the average operation time in the experimental group was 132.93 ±15.25 minutes.P=0.044,there was a statistical difference between the two groups.The operation time of the experimental group was shorter than that of the control group.(8)Time of removing thoracic drainage tube:The average days of closed thoracic drainage in the control group was 5.03 ± 1.426 days,and the average days of closed thoracic drainage in the in the experimental group was 4.50 ± 1.106 days.P=0.111,there was no statistical difference between the two groups.(9)Postoperative complications: two patients in the control group had postoperative pulmonary leakage,and one patient in the experimental group had postoperative pulmonary leakage.There were no postoperative complications such as empyema and lymphatic leakage in the two groups.ConclusionThrough this study,we confirmed that the "selective artificial pneumothorax assisted target artery resection" can quickly and accurately determine the inter-segmental plane when performing thoracoscopic assisted anatomical segmental pulmonary resection,and is also effective for the preservation of inter-segmental veins.In addition,this method does not require additional special equipment and is easy to operate.During the operation,this method can ensure the continuous expansion of the target lung tissue,and play a guiding role in the anatomical dissociation of the lung parenchyma,so as to improve the success rate of the operation and better benefit the patients. |
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