| Objective: To explore the application value of quantitative CT lung volume analysis in the evaluation and prediction of preoperative and postoperative lung function in NSCLC patients undergoing lobectomy or segmentectomy,and to analyze the multiple influencing factors of postoperative lung volume compensation.Methods: A total of 80 NSCLC patients who underwent thoracoscopic lobectomy or segmentectomy in the Department of Thoracic Surgery,Affiliated Hospital of Southwest Medical University from September 2020 to December2021 and underwent quantitative CT lung(QCT)and general pulmonary function test(PFT)in the hospital 1 week before surgery,1 month and 6 months after surgery were included in the study.Statistics in patients with clinical characteristics(age,gender,smoking index,body mass index(BMI)and pre and postoperative complications,pulmonary elastic fiber.),QCT index(inspiratory phase lung volume Vin,respiratory phase lung volume Vex,predict lung volume Pred V,bronchial angle,etc.),PFT indicators include FVC,FEV1,FEV1%/FVC,TLC,RV.Statistical analysis was performed with SPSS26.0software.Patients were divided into two subgroups,namely,lobectomy and segmentectomy,according to surgical methods.Univariate analysis was performed on the differences of general and clinical data,preoperative and postoperative PFT,QCT of patients with two groups.The correlation between preoperative QCT indexes and preoperative PFT indexes,and correlation between predicted QCT indexes and postoperative PFT indexes were analyzed by Pearson’s method.Binary logistic regression analysis was conducted with postoperative lung volume compensation settled as the dependent variable,and gender,age,BMI,pulmonary elastic fiber expression and postoperative bronchial Angle change as independent variables,and the statistical results were statistically significant when P < 0.05.Results:(1)60 patients underwent lobectomy,including 24 cases of the upper lobe of right lung,9 cases of the middle lobe of right lung,10 cases of the lower lobe of right lung,11 cases of the upper lobe of left lung,and 6 cases of the lower lobe of left lung;20 patients underwent segmentectomy,including4 cases of RS1,3 cases of RS2,1 case of RS3,2 cases of RS6,6 cases of LS1+2,1 case of LS3,2 cases of LS4+5,and 1 case of LS7+8.There were no statistically significant differences in gender,age,smoking index,BMI,postoperative pulmonary complications and other indicators between 2 groups(P > 0.05),but there were statistically significant differences in preoperative complications(P < 0.05).There were 37 patients with good expression of PEF,and 43 patients with bad expression.,The Post6 M Angle between bronchus and trachea changed<5° were 50 cases,and 30 cases ≥5°.(2)PFT indicators: There were no statistically significant differences in preoperative FEV1,FVC,FEV1/FVC,TLC and RV between the lobectomy group and the segmentectomy group(P > 0.05),but there were statistically significant differences in FEV1,FVC,TLC and RV Post1M(P < 0.05).There was no significant difference in lung function indexes between the two groups Post6M(P > 0.05).QCT indicators: There was no statistical difference in lung volume indexes between lobectomy and segmenectomy preoperative,Post1 M and Post6M(P > 0.05),but there was statistical difference in lung volume indexes between lobectomy and segmentectomy before and after surgery(P <0.05).In the segmentectomy group,only the Vin between preoperative and postoperative 1 month was statistically significant(P < 0.05).(3)Preoperative CT lung volume analysis had a good correlation with preoperative FEV1,FVC,FEV1/FVC,TLC and RV,and the correlation coefficient r was in the range of 0.247-0.776(P < 0.05).The predicted value of lung volume had a good correlation with postoperative FEV1,FVC,FEV1/FVC and TLC.R ranged from 0.242 to 0.742(P < 0.05).(4)In univariate analysis,age < 60 years old,smoking index < 200,and good expression of pulmonary elastic fiber were important factors for better postoperative lung volume compensation.When considering the influence of multiple factors such as gender,age,smoking index,BMI and bronchial Angle change on patients’ postoperative lung volume compensation ability,the results of binary logistic regression analysis indicated that pulmonary elastic fiber expression was an important factor affecting patients’ postoperative lung volume compensation(P < 0.01).Conclusion:(1)Quantitative CT lung volume analysis has a good correlation with lung function,which can be used to directionally evaluate the lung function of the surgical lobe and predict the postoperative lung volume.Besides,the radiation dose is low and the patient coordination degree is high,which is suitable for combined application with PFT in NSCLC patients undergoing surgery.(2)Younger age,lower smoking index and better expression of PEF were positively correlated with postoperative pulmonary compensation.(3)Segmentectomy has an advantage over lobectomy in early stage postoperative lung function protection,but the advantage gradually decreases with time. |
