| Project/Area Number |
18K16428
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| Research Category |
Grant-in-Aid for Early-Career Scientists
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| Allocation Type | Multi-year Fund |
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| Review Section |
Basic Section 55040:Respiratory surgery-related
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| Research Institution | Juntendo University |
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Principal Investigator |
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| Project Period (FY) |
2018-04-01 – 2023-03-31
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| Project Status |
Completed (Fiscal Year 2022)
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| Budget Amount *help |
¥4,160,000 (Direct Cost: ¥3,200,000、Indirect Cost: ¥960,000)
Fiscal Year 2020: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000)
Fiscal Year 2019: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000)
Fiscal Year 2018: ¥1,820,000 (Direct Cost: ¥1,400,000、Indirect Cost: ¥420,000)
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| Keywords | 肺静脈断端血栓 / 術後脳梗塞 / 左側肺切除 / 脳梗塞 / 左側肺切除術 / ヘパリン / 抗凝固薬 / 肺静脈血栓 / 左側手術 / 肺葉切除 |
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| Outline of Final Research Achievements |
This is a prospective multicentre observational study conducted by 14 institutions in Japan. Postoperative contrast-enhanced computed tomography was performed for 1040 patients in the early period after the pulmonary resection to evaluate the incidence of PVST.
PVST was found in 127 (12.2%) patients with left-sided (23.3%) predominance compared to the right side (4.9%) (P < 0.001). Furthermore, left upper lobectomy was the most frequent operative procedure (30.8%). Multivariable analyses demonstrated that left upper lobectomy (P = 0.001) and left-sided pulmonary resection (P < 0.001) were independent significant predictors of PVST. Cerebral infarction was observed in 9 (0.87%) patients during this period and included 6 (1.46%) in whom it developed after the operation was performed on the left side. Especially in the early postoperative phase, left pulmonary resection was significantly associated with the incidence of cerebral infarction (0.16% vs 1.21%; P = 0.028).
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| Academic Significance and Societal Importance of the Research Achievements |
致死的術後合併症となり得る肺切除術後脳梗塞の発症に関して、左上葉切除後に残存する肺静脈切離断端に血栓を形成する事が脳梗塞発症の危険因子である可能性が報告されている。そこで、本研究では前向きに胸部造影CTを撮像し、実際の肺静脈断端血栓形成頻度と、好発部位を明らかにする事を目的とした。
他施設共同研究により1040症例の集積を終え、肺静脈血栓発症のリスク因子、頻度や臨床病理学的特徴について解析を施行した結果、肺静脈血栓は術後早期に形成され、左側手術に有意に多いことが判明した。更に、術後早期の脳梗塞発症率も左側術後に有意に高いことから、術後脳梗塞の一因である可能性が高いことが示される結果となった。
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