视频辅助分泌术后慢性咳的肺漫神经切断:一个随机对照试验
Qianqian Zhang1,2, Yong Ge3,4, Teng Sun3,4
1Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University.
International journal of surgery (London, England)
|December 20, 2023
概括
在肺叶切除术后切断迷走神经分支显著减少了3个月和2年的慢性咳. 这种手术技术没有对肺功能产生负面影响,也没有增加并发症.
科学领域:
- 胸部外科手术 胸部外科手术
- 肺部医学 肺部医学
- 手术创新 在外科创新.
背景情况:
- 慢性咳是肺叶切除术后经常出现的并发症.
- 迷走神经在咳反射中发挥作用,这表明它的分支可能是预防的目标.
- 目前的胸部外科手术指南缺乏具体的建议来管理肺部迷走神经分支.
研究的目的:
- 为了研究穿刺流动神经特定肺部分支在视频辅助胸腔镜分泌术后预防慢性咳的疗效.
- 评估这种阴道切除术对术后肺功能和并发症的影响.
主要方法:
- 一个单中心,随机对照试验,涉及成人患者接受选择性视频辅助胸腔镜叶切除术和淋巴切除术.
- 患者被随机分为1:1进行假手术 (对照) 或切断提供支气管茎和尾部肺分支的迷走神经分支.
- 主要结局是手术后3个月慢性咳的发生率,评估在治疗意图人口中.
主要成果:
- 3个月后慢性咳的发生率在阴道切除组 (19.0%) 与对照组 (41.4%) (P=0.009) 相比显著较低.
- 在2年的随访中,在阴道切除组 (1.9%) 和对照组 (12.7%) (P=0.032) 中,持续性咳也减少了.
- 在术后并发症或关键肺功能指标 (例如,MVV,DLCO,FEV1) 中没有观察到群体之间的显著差异.
结论:
- 切断肺流动神经分支是一种有效的策略,以减少肺叶切除术后慢性咳的发生率.
- 这种手术干预不会损害肺功能或增加并发症的风险.
- 这些发现支持在胸部手术中考虑迷走神经分支管理,以减轻手术后的咳.
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