Background: Complete thoracoscopic segmentectomy gained great attention with the high detection rate of early lung cancer. Electrocautery and stapler are most commonly used in dividing the intersegmental plane in pulmonary segmentectomy. However, few reports comparing the two methods exist; all of which contrapose an open approach because complete thoracoscopic approach is not mentioned. The aim of this study is to evaluate and compare the safety and efficacy of the two methods in intersegmental plane dissection during complete thoracoscopic pulmonary segmentectomy.
Methods: A retrospective review of prospectively collected data was obtained for 58 consecutive patients who were treated by segmentectomy between September 2013 and March 2016 at a single center. The patients were divided into two groups according to the methods in intersegmental plane dissection. Thirty patients underwent intersegmental plane dissection with electrocautery (electrocautery group), and 28 patients underwent the same process using staplers (stapler group). Preoperative, intraoperative, and postoperative variables for patients were compared between two groups.
Results: The operative time of electrocautery group was longer than that of the stapler group [(248.70±54.46) min vs (209.39±67.25) min, P=0.017]. Furthermore, no statistical difference was found between two groups in intraoperative blood loss (60.00 mL vs 65.00 mL), total drainage volume (445.00 mL vs 590.00 mL), drainage volume in first 3 days after surgery [(455.33±318.333) mL vs (422.32±194.95) mL], duration of chest tube drainage [(4.20±2.07) d vs (4.11±1.61) d], postoperative hospital stay [(6.33±2.98) d vs (5.89±1.55) d], and incidence of minor postoperative complication [16.7% (5/30) vs 7.1% (2/28)].
Conclusions: Although operative time was longer in electrocautery group than in stapler group, using electrocautery for intersegmental plane dissection in complete thoracoscopic segmentectomy appeared to be a very safe and feasible procedure compared with stapler.
背景与目的 全胸腔镜肺段切除术随早期肺癌的高检出率逐渐受到关注，其中肺段切除术段间平面分离最常用的方法是电刀切割手工缝合和应用直线切割缝合器机械切割两种。但仅有很少的研究对两者进行对比，且均针对开放式肺段切除术，目前尚未有相应的研究针对全胸腔镜肺段切除术。本研究旨在探讨两种方法在全胸腔镜手术中的应用及安全性对比。方法 回顾性分析2013年9月-2016年3月北京大学第一医院胸外科行全胸腔镜肺段切除术的连续58例患者，根据段间平面分离方法不同分为电刀切割组30例和机械切割组28例，对两组患者手术时间、出血量、术后胸管留置时间、术后住院时间、胸腔引流量及术后并发症进行比较。结果 除手术时间[电刀切割组（248.70±54.46）min和机械切割组（209.39±67.25）min]两组间有统计学差异（P=0.017）外，术中出血量（60.00 mL vs 65.00 mL）、胸腔引流总量（445.00 mL vs 590.00 mL）、术后3天胸腔引流量[（455.33±318.333）mL vs（422.32±194.95）mL]、术后胸管留置时间（3.50天 vs 4.00天）和术后住院时间（6.00天 vs 6.00天）、术后并发症发生率（5/30 vs 2/28），两组差异均无统计学意义。结论 全胸腔镜肺段切除术段间平面的分离方法中，应用电刀切割手工缝合手术时间相对较长，但安全性不劣于应用切割缝合器机械切割缝合。.