关键词: Muscle atrophy Nerve injury Pulmonary lobectomy Thoracic surgery

Mesh : Humans Male Female Retrospective Studies Middle Aged Aged Rectus Abdominis / pathology innervation surgery diagnostic imaging Pneumonectomy / adverse effects methods Muscular Atrophy / etiology pathology Postoperative Complications / etiology epidemiology Tomography, X-Ray Computed Adult

来  源:   DOI:10.1016/j.jss.2024.04.011

Abstract:
BACKGROUND: Pulmonary lobectomy can result in intercostal nerve injury, leading to denervation of the rectus abdominis (RA) resulting in asymmetric muscle atrophy or an abdominal bulge. While there is a high rate of intercostal nerve injury during thoracic surgery, there are no studies that evaluate the magnitude and predisposing factors for RA atrophy in a large cohort.
METHODS: A retrospective chart review was conducted of 357 patients who underwent open, thoracoscopic or robotic pulmonary lobectomy at a single academic center. RA volumes were measured on computed tomography scans preoperatively and postoperatively on both the operated and nonoperated sides from the level of the xiphoid process to the thoracolumbar junction. RA volume change and association of surgical/demographic characteristics was assessed.
RESULTS: Median RA volume decreased bilaterally after operation, decreasing significantly more on the operated side (-19.5%) versus the nonoperated side (-6.6%) (P < 0.0001). 80.4% of the analyzed cohort experienced a 10% or greater decrease from preoperative RA volume on the operated side. Overweight individuals (body mass index 25.5-29.9) experienced a 1.7-fold greater volume loss on the operated side compared to normal weight individuals (body mass index 18.5-24.9) (P = 0.00016). In all right-sided lobectomies, lower lobe resection had the highest postoperative volume loss (Median (interquartile range): -28 (-35, -15)) (P = 0.082).
CONCLUSIONS: This study of postlobectomy RA asymmetry includes the largest cohort to date; previous literature only includes case reports. Lobectomy operations result in asymmetric RA atrophy and predisposing factors include demographics and surgical approach. Clinical and quality of life outcomes of RA atrophy, along with mitigation strategies, must be assessed.
摘要:
背景:肺叶切除术可导致肋间神经损伤,导致腹直肌(RA)神经支配,导致不对称肌肉萎缩或腹部隆起。虽然胸部手术中肋间神经损伤的发生率很高,在大型队列中,尚无研究评估RA萎缩的程度和诱发因素.
方法:对357例患者进行了回顾性分析,在单个学术中心进行胸腔镜或机器人肺叶切除术。术前和术后从剑突水平到胸腰椎交界处,在手术和非手术侧进行计算机断层扫描扫描,测量RA体积。评估RA体积变化和手术/人口统计学特征的关联。
结果:术后双侧RA容积中位数下降,手术侧(-19.5%)与非手术侧(-6.6%)的下降幅度更大(P<0.0001)。80.4%的分析队列在手术侧经历了与术前RA体积相比10%或更多的减少。与正常体重个体(体重指数18.5-24.9)相比,超重个体(体重指数25.5-29.9)在手术侧经历了1.7倍的体积损失(P=0.00016)。在所有右侧的肝切除术中,下叶切除术的术后体积损失最高(中位数(四分位距):-28(-35,-15))(P=0.082).
结论:这项关于肺叶切除术后RA不对称性的研究包括了迄今为止最大的队列;以前的文献仅包括病例报告。肺叶切除术导致不对称RA萎缩,诱发因素包括人口统计学和手术方法。RA萎缩的临床和生活质量结局,以及缓解策略,必须评估。
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