MU Guang 1 , ZHANG Wenhao 1 , WANG Hongchang 1 , GU Yan 1 , FU Chenghao 1 , XUE Wentao 1 , XIE Shiyuan 2 , WANG Tong 2 , WEI Ke 1 , XIA Yang 1 , CHEN Liang 1 , WANG Jun 1
  • 1. Department of Thoracic Surgery, Jiangsu Provincial Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210000, P. R. China;
  • 2. Nanjing Medical University, Nanjing, 211166, P. R. China;
WANG Jun, Email: drwangjun@njmu.edu.cn
Right upper lobectomy; inferior pulmonary ligament division; residual lung expansion; postoperative residual cavity; body mass index
10.7507/1007-4848.202401038
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Objective To analyze the effect of releasing the lower pulmonary ligament on right residual lung expansion after right upper lobe resection under different body mass index (BMI) levels. Methods The clinical data of patients who underwent thoracoscopic right upper lobe resection in the First Affiliated Hospital with Nanjing Medical University from 2021 to 2022 were retrospectively analyzed. Patients were divided into a group A (17 kg/m2＜BMI≤23 kg/m2), a group B (23 kg/m2＜BMI≤29 kg/m2) and a group C (BMI＞29 kg/m2) according to BMI. The presence of residual cavity was judged by chest X-ray at 7-10 days after operation, the degree of compensation change of the right main bronchus angle was measured, and the changes in lung volume were determined by CT three-dimensional reconstruction. Results A total of 157 patients who underwent thoracoscopic right upper lobe resection were included, including 71 males and 86 females, with an average age of 59.7±11.2 years. There were 50 patients in the group A, 75 patients in the group B, and 32 patients in the group C. In the group A, compared with those without releasing the lower pulmonary ligament, patients with releasing had a lower incidence of postoperative residual cavity (P=0.016), greater changes in bronchus angle (P<0.001), and smaller changes in lung volume (P<0.001). In the group B and C, there was no significant effect of releasing the lower pulmonary ligament on postoperative residual cavity, bronchus angle, and lung volume changes (P>0.05). Conclusion For patients with thin and long body shape and low BMI, releasing the lower pulmonary ligament is helpful to promote the expansion of the residual lung after right upper lobe resection and reduce the occurrence of postoperative residual cavity in patients.