Clinical Observation Of Patients After Sugery Of Preserved Pulmonary Ligament In Video-assisted Thoracic Surgery(VATS) Upper Lobectomy

Purpose Lung cancer is one of the most serious malignant tumors.It is hard to argue that any pulmonary disease has undergone a more dramatic transformation over the past century than lung cancer.More than 100 years ago,lung cancer was an extremely rare disease.Today,lung cancer is the leading cause of cancer deaths worldwide in both men and women.With the rapid development of anesthesia and surgical techniques,video-assisted thoracoscopy(VATS)lobectomy has become the first choice for the treatment of early lung-type lung cancer.It has been recognized and widely used by most thoracic surgeons in clinical practice.Whether dissecting the inferior pulmonary ligaments during VATS superior lobectomy for early stage lung cancer remains controversial.During superior lobectomy,thoracic surgeons routinely dissect the inferior pulmonary ligaments,which can reduce the limitation of the range of motion of the inferior lobe,improve the reexpansion of the inferior lobe,improve the filling of the residual cavity of the superior lobe,and reduce the complication rate.Currently,there is no evidence confirming that dissecting inferior pulmonary ligaments can improve the prognosis and reduce the complication rate.Therefore,the main purpose of the present study was to compare the outcomes between patients in whom the inferior pulmonary ligaments were preserved or not during superior lobectomy.Methods A total of 130 lung cancer patients were selected according to the adopt standardization from June 2017 to October 2018(61 left,69 right).All of the patients were divided into two groups: the division group,who underwent division of the inferior pulmonary ligament,and the preservation group,who did not.The division group included 65 patients,while the preservation group included 65.To assess upward movement of the nonoperated lobes,chest X-ray films were done at preoperatively and 1 month postoperatively.To assess the change in the angle of the main bronchus,chest CT films were done preoperatively and 3 month postoperatively.To assess the change in the pulmonary function,pulmonary function testing were done preoperatively and 3 month postoperatively.And two groups were investigated by Mandarin Chinese version of the Leicester Cough Questionnaire(LCQ-MC).We analyzed and calculated the dead space,the change in the angle of the main bronchus,the change in the pulmonary function and the preoperative and postoperative ratio scores of LCQ-MCResults 1.The dead space ratio did not differ significantly between the division group and the preservation group(P > 0.05).2.The changes in bronchus angle in the preservation group were significantly smaller than those in the division group after right lung operation(17.20±8.49° vs 23.88±12.69°,P < 0.05);in the left lung,the changes were not significant between the two groups(P > 0.05).3.The changes in forced expiratory volume in one second(FEV1)and peak expiratory flow(PEF)were significantly better in the preservation group than those in division group after right lung operation(0.444±0.376 vs 0.721±0.590,1.080±0.814 vs 1.724±1.385,P < 0.05);in the left lung,the changes were not significant between the two groups(P > 0.05).4.In the left lung patients,the preoperative score of LCQ-MC was significantly higher than postoperative score,but the postoperative score of LCQ-MC was not statistically different between the two groups(P > 0.05);The postoperative score of LCQ-MC was significantly higher in the preservation group than that of the division group after right lung operation(P < 0.05),and cough were relieved in the preservation group.Conclusions 1.Division of the inferior pulmonary ligaments after upper lobectomy is less effective for the obliteration of dead space than leaving it intact.2.Preservation of inferior pulmonary ligaments during right upper lobectomy might reduce bronchial distortion.3.Preservation of inferior pulmonary ligaments during right upper lobectomy might improve the recovery of pulmonary function 4.Preserved of inferior pulmonary ligament during right upper lobectomy can reduce the cough after surgery.