超声测量膈肌移动度评估电视辅助胸腔镜手术肺叶及肺段切除后膈肌功能恢复的价值

吕冬琴; 徐磊; 朱启航; 朱贤胜

doi:10.7619/jcmp.20214276

超声测量膈肌移动度评估电视辅助胸腔镜手术肺叶及肺段切除后膈肌功能恢复的价值

吕冬琴^{1, 4},
徐磊²,
朱启航³,
朱贤胜^{1, 4, ,}

1.
南方医科大学第一临床医学院, 广东广州, 510515
2.
中国人民解放军陆军军医大学第二附属医院超声科, 重庆, 400038
3.
中国人民解放军南部战区总医院胸外科, 广东广州, 510010
4.
中国人民解放军南部战区总医院超声诊断科, 广东广州, 510010

详细信息

通讯作者:
朱贤胜, E-mail: zxsh873376@163.com

中图分类号: R563;R445.1
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出版历程
- 收稿日期: 2021-10-30
- 网络出版日期: 2022-03-28
- 发布日期: 2022-03-14

Value of diaphragmatic excursion detected by ultrasound in evaluating diaphragm function recovery after lobectomy and segmentectomy with video-assisted thoracoscopic surgery

LYU Dongqin^{1, 4},
XU Lei²,
ZHU Qihang³,
ZHU Xiansheng^{1, 4, ,}

1.
the First Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, 510515
2.
Department of Ultrasound, the Second Affiliated Hospital of Army Medical University of the Chinese People's Liberation Army, Chongqing, 400038
3.
Department of Thoracic Surgery, General Hospital of Southern Theatre Command of the Chinese People's Liberation Army, Guangzhou, Guangdong, 510010
4.
Department of Ultrasonic Diagnosis, General Hospital of Southern Theatre Command of the Chinese People's Liberation Army, Guangzhou, Guangdong, 510010

摘要

摘要:
目的探讨超声测量膈肌移动度（DE）评估电视辅助胸腔镜手术（VATS）肺叶及肺段切除术后膈肌功能恢复的价值。
方法将孤立性肺结节行VATS治疗的54例患者根据手术方式的不同分为肺叶切除组32例和肺段切除组22例。比较2组患者术前及术后第1、3、5、7天双侧DE，比较2组患者手术相关指标。
结果 2组均顺利完成手术，无中转开胸或二次手术者。超声测量平静呼吸时的DE结果显示，肺段切除组术后第1、3、5、7天手术侧DE高于肺叶切除组，差异有统计学意义（P < 0.05）；2组术前及术后第1、3、5、7天健侧DE比较，差异均无统计学意义（P>0.05）。肺段切除组术中失血量、术后前3 d引流量、总引流量、术后住院时间均低于肺叶切除组，差异有统计学意义（P < 0.05）。术后病理结果显示，肺叶切除组恶性病变率为81.3%（26/32），肺段切除组恶性病变率为77.3%（17/22），差异无统计学意义（P>0.05）。
结论 VATS肺段与肺叶切除术后膈肌功能历经短暂降低后逐渐增高，分别于术后第5、7天恢复至术前水平，为临床VATS后膈肌功能恢复时间提供参考，也可帮助诊断术后膈肌功能障碍。
- 膈肌移动度 /
- 电视辅助胸腔镜手术 /
- 肺叶切除术 /
- 肺段切除术 /
- 超声
Abstract:
Objective To explore the value of diaphragmatic excursion (DE) detected by ultrasound in evaluating diaphragm function recovery after lobectomy and segmentectomy with video-assisted thoracoscopic surgery (VATS).
Methods Fifty-four patients with VATS therapy for solitary pulmonary nodules were divided into lobectomy group (n=32) and segmentectomy group (n=22) according to the surgical methods. The bilateral DE values before operation and on the 1st, 3rd, 5th and 7th day after operation were compared between two groups, and the operation related indexes in both groups were compared as well.
Results The operations were successfully completed in both groups, and there were no cases with conversion to thoracotomy or secondary operations. The results of DE measured by ultrasound in calm breathing status showed that the DE values of the surgical side in the segmentectomy group were significantly higher than those in the lobectomy group on the 1st, 3rd, 5th and 7th day after operation (P < 0.05); there were no significant differences in DE values of healthy side between the two groups before operation and on the 1st, 3rd, 5th and 7th day after operation (P>0.05). The intraoperative blood loss, drainage volume in the first 3 days after operation, total drainage volume and postoperative hospital stay in the segmentectomy group were significantly lower than those in the lobectomy group (P < 0.05). The postoperative pathological results showed that the malignant lesion rate was 81.3% (26/32) in the lobectomy group and 77.3% (17/22) in the segmentectomy group, and there was no significant difference between two groups (P>0.05).
Conclusion After segmentectomy and lobectomy with VATS, the diaphragm function increases gradually after a momentary decrease, and recovers to the preoperative level on the 5th and 7th day respectively, which can provide reference for the recovery time of diaphragm function after VATS and help diagnose postoperative diaphragmatic dysfunction.
- diaphragmatic excursion /
- video-assisted thoracoscopic surgery /
- lobectomy /
- segmentectomy /
- ultrasound

HTML全文

表 1 肺叶切除组与肺段切除组患者一般资料比较(x±s)[M(IQR)]

一般资料		肺叶切除组(n=32)	肺段切除组(n=22)
年龄/岁		58.0±10.0	58.0±12.0
性别	男	12	10
	女	20	12
身高/cm		161.7±6.8	162.5±8.7
体质量/kg		62.6±9.8	62.3±11.9
体质量指数/(kg/m²)		23.9±3.1	23.4±2.8
病灶位置	左上肺叶	7	6
	左下肺叶	5	3
	右上肺叶	8	8
	右中肺叶	3	0
	右下肺叶	9	5
病灶直径/mm		19.4±7.7	17.7±9.8
手术方式	单孔	13	12
	双孔	19	10
术前肺功能	用力肺活量/L	2.8±0.6	3.2±1.1
	第1秒用力呼气容积/L	2.2±0.5	2.5±0.8
	每分钟最大通气量/(L/min)	78.3±19.7	88.6(27.7)
	肺一氧化碳弥散因子/[mmol/(min·kPa)]	6.7±1.0	7.5±2.1

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表 2 2组术前及术后第1、3、5、7天平静呼吸时DE比较(x±s) mm

时点	位置	肺叶切除组(n=32)	肺段切除组(n=22)
术前	手术侧	16.1±7.0	18.2±4.7
	健侧	16.7±6.2	19.6±4.5
术后第1天	手术侧	6.5±4.4	11.4±4.7^*
	健侧	19.5±7.7	17.8±7.0
术后第3天	手术侧	8.3±4.0	14.5±5.0^*
	健侧	19.0±7.5	20.2±5.8
术后第5天	手术侧	9.0±4.0	15.8±5.2^*
	健侧	20.3±9.1	19.3±6.6
第7天	手术侧	12.7±4.2	17.2±4.2^*
	健侧	18.6±4.3	19.3±4.0
与肺叶切除组比较, *P < 0.05。

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表 3 2组手术相关指标比较(x±s)[M(IQR)]

指标	肺叶切除组(n=32)	肺段切除组(n=22)
手术时间/min	150.0(53.0)	155.0(119.0)
术中失血量/mL	100.0(175.0)	50.0(72.0)^*
引流时间/d	3.0(3.0)	3.0(0.5)
术后前3 d引流量/mL	703.0±372.0	434.0±271.0^*
总引流量/mL	814.0±452.0	467.0±321.0^*
术后住院时间/d	7.8(1.5)	5.8±1.3^*
与肺叶切除组比较, *P < 0.05。

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