关键词: 非小细胞肺癌, 荧光胸腔镜, 流域分析, 解剖性, 亚肺叶切除术

Abstract: Objective To investigate the clinical value of watershed analysis to anatomical sublobectomy in the treatment of early peripheral Non-Small-Cell Lung Carcinoma(NSCLC) characterized by Ground Glass Nodules(GGN) through fluorescence thoracoscopy. Method A total of 81 cases of early peripheral GGN-like non-small-cell lung carcinoma treated by thoracic surgery in our hospital from September 2021 to September 2022 were retrospectively studied.According to the different methods of fluorescence thoracoscopic surgery,the patients were divided into two groups.The group of anatomical sublobectomy with the watershed analysis(hereinafter,referred to as the watershed group) including 42 cases,and the anatomical pulmonary segmental resection group(hereinafter,referred to as the pulmonary segmental resection group) including 39 cases.The general surgical data,perioperative indexes and postoperative complications were compared between the two groups. Results The operations of the patients were successfully completed for both groups,without any perioperative death.For the watershed group,there were no cases that switched to thoracotomy or changed the operation style,and no cases of incision or missed incision were observed.For the pulmonary segmental resection group,there were 2 cases that changed the operation style.The surgical margin distance of the watershed group[(26.24±3.87)mm] was slightly smaller than that of the pulmonary segmental resection group[(26.62±3.32)mm].But the difference was not statistically significant(P>0.05).The amount of blood loss[32.14(20.00,50.00)ml vs 85.38(30,100)ml],operative time[(146.76±41.51)min vs (184.944±50.42)min] and postoperative drainage time[2.43(2.00,3.00)d vs 4.05(3.00,5.00)d] of the watershed group were lower than those of the pulmonary segmental resection group.And the differences were statistically significant(P<0.05).The complication rate of the watershed group(11.91%) was lower than that of the pulmonary segmental resection group(30.77%).And the difference was statistically significant(P<0.05).Totally,25 patients(64.12%) in the pulmonary segmental resection group underwent the preoperative puncture localization,but none in the watershed group.For both groups,there was no tumor recurrence during the follow-up.Conclusion The application of watershed analysis to anatomical sublobectomy in the treatment of early peripheral NSCLC by fluorescent thoracoscopy can simplify the surgical procedure,accurately remove the lesion,and ensure the curative effect of oncology.The clinical practices have proved that the approach is scientifically reasonable,safe and feasible.

Key words: non-small-cell lung Carcinoma, fluorescent thoracoscopy, watershed analysis, anatomical, sublobectomy