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.
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