三维重建技术在胸腔镜精准肺段切除中的临床应用  

Clinical application of three-dimensional computed tomography bronchography and angiography in thoracoscopic segmentectomy

作　　者：黄艾 瞿越 余政 江科 邢世杰 Huang Ai;Qu Yue;Yu Zheng;Jiang Ke;Xing Shijie(Department of Thoracic Surgery,Union Hospital Affiliated with Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院胸外科

出　　处：《中国医师杂志》2019年第11期1609-1612,共4页Journal of Chinese Physician

摘　　要：目的初步探讨三维计算机断层扫描支气管血管成像(3D-CTBA)技术在胸腔镜下解剖性肺段或联合肺段切除手术中的临床价值。方法回顾性分析2017年9月至2019年8月华中科技大学同济医学院附属协和医院胸外科收治的30例孤立或多发肺结节患者的临床资料。所有病例术前应用3D-CTBA精准定位结节,明确支气管、血管走行,观察有无变异。术中精准离断靶段支气管、靶段动脉及相应静脉,使用膨胀-萎陷法确定段间平面。结果全组实施肺段切除13例,联合肺段切除术17例。结节直径(11.56±3.79)mm,结节深度(距脏层胸膜最短距离)(13.88±3.96)mm,手术时间(134.94±18.68)min,术中出血量(94.38±37.94)ml。术中淋巴结快速病理检查均未查见癌转移。均无中转开胸。胸管留置时间(3.69±1.30)d,术后住院时间(4.81±1.47)d。病理结果显示:良性病变2例,腺上皮异常增生2例,原位腺癌5例,微浸润性肺腺癌10例,浸润性腺癌(贴壁生长)11例。围手术期无严重并发症,无死亡病例。结论术前应用三维重建技术评估后行胸腔镜肺段切除手术,可实现精准的肺段切除且安全有效。Objective To explore the clinical value of three-dimensional computed tomography bronchography and angiography( 3 D-CTBA) in thoracoscopic dissection or combined segmentectomy.Methods The clinical data of 30 patients with isolated or multiple pulmonary nodules from September 2017 to August 2019 were retrospectively analyzed. All cases were treated with 3 D-CTBA to locate the nodules accurately before operations,in order to explicit the courses of bronchi and vessels,and to observe the variations. The target bronchi,arteries and veins were resected accurately during the operations,and the intersegmental plane was determined by expansion-collapse method. Results 13 patients underwent segmentectomy and 17 patients underwent combined segmentectomy. The diameter of the nodule was( 11. 56 ± 3. 79)mm;the depth of the nodule( the shortest distance from the visceral pleura) was( 13. 88 ± 3. 96) mm;the operation time was( 134. 94 ± 18. 68) min,and the intraoperative bleeding volume was( 94. 38 ± 37. 94)ml. No cancer metastasis was found by rapid pathological examination of lymph nodes during operations. No conversion to thoracotomy. The indwelling time of thoracic tube was( 3. 69 ± 1. 30) days,and the hospitalization days after operations was( 4. 81 ± 1. 47) days. No serious complications or death during the perioperative period. Conclusions Preoperative 3 D-CTBA has advantages in pulmonary segmentectomy,which is a safe and effective method for accurate segmentectomy.

关 键 词：成像 三维 支气管造影术 胸腔镜检查 肺切除术 

分 类 号：R73[医药卫生—肿瘤]