荧光法在单孔胸腔镜解剖性肺段切除术中处理段间交界面的应用  

Fluorescence method for identification of intersegmental plane in uniportal thoracoscopic pulmonary segmentectomy

作　　者：孙云刚 邵丰[1] 王朝[1] 张强[1] 曹珲[1] 刘政呈[1] 侍晔 杨如松[1] SUN Yun-gang;SHAO Feng;WANG Zhao;ZHANG Qiang;CAO Hui;LIU Zheng-cheng;SHI Ye;YANG Ru-song(Department of Thoracic Surgery, Nanjing Chest Hospital Affiliated to Medical School of Southeast University, Nanjing, Jiangsu 210029,China)

机构地区：[1]东南大学医学院附属南京胸科医院胸外科

出　　处：《中国临床研究》2019年第9期1153-1157,1162,共6页Chinese Journal of Clinical Research

摘　　要：目的探讨使用EDDA软件设计三维气管血管成像导航单孔胸腔镜联合吲哚菁绿荧光法在解剖性肺段切除术中处理段间交界面,并与目前临床较常用的改良膨胀萎陷法相比较,评价其可行性与优势。方法回顾性分析2018年4月至2019年5月在南京胸科医院胸外科进行荧光法单孔胸腔镜解剖性肺段切除术100例患者(荧光法组)的临床资料,其中男性43例,女性57例,年龄23~78岁;另选取同期行改良膨胀萎陷法单孔胸腔镜解剖性肺段切除术患者100例,作为改良膨胀萎陷法组,其中男性48例,女性52例,年龄38~76岁。术前将所有患者的CT扫描数据导入三维智能交互式定性和定量分析(IQQA-3D)图像分析系统,对结节位置进行识别,并对支气管、动脉、静脉等肺部结构进行三维重建,模拟肺段切除所涉及的靶段支气管、动脉和静脉,并确定保留的段间静脉及虚拟的段间交界面。荧光法组患者术中离断靶段肺血管和支气管后,外周静脉注射吲哚菁绿,随后打开PINPOINT荧光胸腔镜的荧光模式,显示明显段间交界面后用电凝烧灼标记。改良膨胀萎陷法组则在精准离断靶段结构后,重新使全肺完全复张,而后恢复健侧单肺通气,随着时间的推移形成一清晰的分界线并予以电凝烧灼标记。记录两组患者的临床资料,对比分析早期临床结果。结果荧光法组除6例右上肺尖段的交界面相对较模糊外,94%(94/100)均可显示清晰的段间交界面,持续时间(179.75±48.81)s,足以完成交界面的标记;与改良膨胀萎陷法组相比,段间交界面清晰出现时间明显提早[(23.59±4.47)s vs(1 026.80±318.34)s,P<0.01],手术时间缩短[(89.28±31.57)min vs(112.80±32.96) min,P<0.01];两组切缘宽度比较无统计学差异[(2.53±0.52)cm vs(2.44±0.48)cm,P=0.237],均符合≥2 cm的肿瘤学要求;两组术中出血量、术后胸管引流时间、术后住院时间、并发症发生率亦无统计学差异(P>0.05),且均无�Objective To investigate the feasibility and advantages of uniportal thoracoscopy and indocyanine green combined with using EDDA to design a 3 D tracheal angiography navigation for identification of intersegmental plane in pulmonary segmentectomy,and to compare with the modified inflation-deflation which is commonly used in clinic.Methods The clinical data of 100 patients who received pulmonary segmentectomy by fluorescence(indocyanine green) and uniportal thoracoscopy from April 2018 to May 2015 in Nanjing Chest Hospital were retrospectively analyzed(fluorescence group,43 males and 57 females,aging from 23 to 78).And a total of 100 patients who received pulmonary segmentectomy by modified inflation-deflation at the same period were selected as modified inflation-deflation group(48 males and 52 females,aging from 38 to 76).Preoperative CT scan data of all patients were imported into the three-dimensional intelligent interactive qualitative and quantitative image analysis system(IQQA-3 D) to identify the location of nodules,and 3 D reconstruction of pulmonary structures such as bronchi,arteries and veins was carried out to simulate the target segments of bronchi,arteries and veins involved in segmentectomy,and to determine their retention.The intersegmental vein and virtual intersegmental interface.In the fluorescence group,indocyanine green was injected into peripheral vein after the target pulmonary vessels and bronchus were cut off during the operation,and then the fluorescence mode of PINPOINT fluorescence thoracoscopy was opened to show the obvious intersection interface and marked by electrocoagulation.In the modified inflation-deflation group,after precisely breaking off the target segment structure,the whole lung was completely reopened,and then the unilateral ventilation was restored.With the passage of time,a clear demarcation line was formed and marked by electrocoagulation and cauterization.The clinical data of the two groups were recorded and the early clinical results were compared and analyzed.Resul

关 键 词：肺段切除术 段间交界面 单孔胸腔镜 荧光法 吲哚菁绿 改良膨胀萎陷法 

分 类 号：R616.2[医药卫生—外科学]