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In recent years, an increasing number of pulmonary nodules have been detected through CT screening. The traditional surgical method for lung cancer is lobectomy combined with lymph node dissection. However, recent studies have demonstrated that sublobar resection for early non-small cell lung cancer (NSCLC) is an effective alternative with the additional benefit of preserving more pulmonary function. However, it also faces many problems, the most prominent of which is the rapid and accurate identification of the intersegmental plane (ISP) during surgery. The modified inflation-deflation method for identifying the ISP is the most commonly used method in anatomical sublobar resection. Nevertheless, the lengthy waiting periods and the lack of clear delineation represent significant challenges in clinical practice. The Partial pressure of Oxygen Control method facilitates the efficient determination of the ISP by reducing the oxygen inhalation concentration and ventilator ventilation time during surgery. This results in a reduced PaO2 in arterial blood, thereby accelerating the rapid appearance of the ISP. Thus, the investigators conducted a prospective, randomized, controlled trial to ascertain whether the oxygen partial pressure control method affects the occurrence time of the ISP and PaO2 during one-lung ventilation, in comparison to the modified inflation-deflation method. Furthermore, the objective was to confirm the safety and efficacy of Partial pressure of Oxygen Control method.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Partial pressure of Oxygen Control method | Experimental | After the targeted structures were successfully dissected, the anesthesiologist manually controls pure oxygen one-lung ventilation on the surgical side until the lung is fully expand. The ventilator is disconnected, the airway is opened, and the operator uses a gauze ball to pressure the preserve lung tissue. At a SpO2 of 95%, the healthy side undergoes one-lung ventilation. |
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| Modified inflation-deflation method | No Intervention | After the targeted structures were successfully dissected, and then the collapsed lung was re-expanded completely with controlled airway pressure under 20 cmH2O, with the bronchus of the operation side open to atmosphere while continuing ventilation of the contralateral lung. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Partial pressure of Oxygen Control method | Procedure | During the process of inflation-deflation, by maintaining a lower PaO2, the identifying the intersegmental plane is accelerated |
| Measure | Description | Time Frame |
|---|---|---|
| Time of Intersegmental plane（TISP） | The start time was defined as the end of the surgical side lung having completely re-expanded. The end point was identified as the point at which the preserved lung was fully deflated, and a boundary had formed between the targeted lung tissue and the reserved lung. | Throughout the entire surgical period，an average of 10 minutes |
| The lung collapse score | The lung collapse score was referenced and improved by the Bussiers method using descriptive and visual features that included the context of lung collapse, space in the thermal cavity, atelectasis, color of the lung (healthy lungs are a pink gray/simple color), and where the collapse was considered satisfactory.Lung collapse was defined on a 4-point scale, where 1 point int=no lung collapse, 2 point=less partial lung collapse, 3 point=major partial lung collapse, 4 point=total lung collapse Each video clip was assessed by 2 evaluators。 Independently evaluate the level, and resolve differences through consensus through negotiation. | Throughout the entire surgical period |
| Measure | Description | Time Frame |
|---|---|---|
| Surgical time | The total time from the start of skin incision to the completion of chest closure | Throughout the entire surgical period，An average of 120 minutes |
| Blood gas analysis | Blood gas analysis measuring before entry, after one lung ventilation (SpO2 maintained at 95%), after pure oxygen lung stimulation, and at 3 and 6 minutes after pure oxygen lung expand. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Xiaolong Yan, MD | Contact | 15991269383 | yanxiaolong@fmmu.edu.cn | |
| Mingliang Xing | Contact | 15129745755 | 312596733@QQ.COM |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Second Affiliated Hospital of the Air Force Medical University of PLA | Recruiting | Xi'an | Shaanxi | 710000 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40083504 | Derived | Xing M, Tong L, Duan H, Aliev D, Dong X, Zhang Y, Liu H, Yan X. Partial pressure of oxygen control versus modified inflation-deflation method in identifying intersegmental plane during anatomical sublobectomy: a prospective, randomized, controlled trial. J Thorac Dis. 2025 Feb 28;17(2):1042-1053. doi: 10.21037/jtd-2025-45. Epub 2025 Feb 27. |
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| ID | Term |
|---|---|
| D008175 | Lung Neoplasms |
| D002289 | Carcinoma, Non-Small-Cell Lung |
| ID | Term |
|---|---|
| D012142 | Respiratory Tract Neoplasms |
| D013899 | Thoracic Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
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| Throughout the entire surgical period，Baseline, Up to 120 minutes |
| Intraoperative bleeding volume | Intraoperative bleeding volume: Use a suction device and a graduated collection device to collect intraoperative bleeding volume in milliliters, accurate to ten digits. (An average of 50ml) | Throughout the entire surgical period |
| Postoperative drainage volume | Postoperative drainage volume: The total drainage volume in the drainage bottle during the retention of the thoracic catheter after surgery, in milliliters. (An average of 200ml) | Intraoperative |
| Postoperative complication incidence | Postoperative complication incidence: Record the name of the complication and classify it according to the Clavien Indo classification system | Throughout the perioperative period，Baseline, Up to 3 months |
| Postoperative hospitalization days | The number of days between the surgical date and the discharge date; | From surgery to discharge ，An average of 5 days |
| Total hospitalization cost | Total hospitalization cost: The total cost of patients from admission to discharge, settled in ChiNaYuan（CNY） (before medical insurance settlement). | Up to 3 months |
| D008171 |
| Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D002283 | Carcinoma, Bronchogenic |
| D001984 | Bronchial Neoplasms |