三维重建指导下解剖性肺段切除43例分析  

Analysis on 43 cases of anatomic resection of pulmonary segments guided by 3D reconstruction

作　　者：申江峰[1] 贾卫光 王鹏程[1] 卢开进 郑一鸣[1] 谢于峰 SHEN Jiangfeng;JIA Weiguang;WANG Pengcheng;LU Kaijin;ZHENG Yiming;XIE Yufeng(Department of Thoracic Surgery,Taizhou People’s Hospital in Jiangsu Province,Taizhou 225300,China)

机构地区：[1]江苏省泰州市人民医院胸外科,江苏泰州225300

出　　处：《中国现代医生》2020年第13期57-59,71,I0002,共5页China Modern Doctor

摘　　要：目的探讨胸腔镜下肺段解剖性切除的临床应用及临床价值。方法回顾性分析2016年3月~2019年9月期间完成的43例胸腔镜解剖性肺段切除术的临床资料。男16例,女27例;年龄36~75岁,平均(48.4±3.5)岁。术前常规行CT三维重建,了解血管及气管情况及其变异,明确病灶解剖定位,制定手术计划,采用经典三孔法,根据不同肺段采用不同手术流程,采用膨胀萎陷法结合段间静脉确定段间平面,使用电刀超声刀分离和腔镜切割缝合器离断段间肺实质。结果单纯肺段切除33例,联合肺段切除10例。术后病理结果显示良性病变6例,原发性肺癌34例,转移性癌3例。手术耗时50~180 min,平均(110±8)min;出血量20~280 mL,平均(50.0±5.5)mL;术后住院6~14 d,平均(9.7±1.2)d。无围手术期死亡患者,术后并发症5例(11.6%),其中术后咯血2例,肺漏气时间过长、肺部感染、胸腔积液各1例,所有并发症均治愈。结论通过术前三维重建,可以精准了解肺内结构,精确指导手术,缩短肺段手术学习曲线,使得胸腔镜肺段切除术更为精准、安全、可行。Objective To explore the clinical application and clinical value of anatomical resection of pulmonary segments under thoracoscopy.Methods Clinical data of 43 cases of thoracoscopic anatomical resection of pulmonary segments performed from March 2016 to September 2019 were retrospectively analyzed.There were 16 males and 27 females,aged 36 to 75 years,with an average of(48.4±3.5)years of age.Pre-operative CT three-dimensional reconstruction was performed to understand the conditions of blood vessels and trachea and their variations,determine the anatomical location of the lesion,and formulate a surgical plan.The classic three-hole method was adopted,different surgical procedures were adopted according to different pulmonary segments,and the swelling and collapse method was used in combination with the intersegmental veins to determine the intersegmental plane.The electrosurgical ultrasonic knife and laparoscopic cutting and suture instrument were used to separate the intersegmental lung parenchyma.Results There were 33 cases of simple resection of pulmonary segments and 10 cases of combined resection of pulmonary segments.Postoperative pathological results showed 6 cases of benign lesions,34 cases of primary lung cancer,and 3 cases of metastatic cancer.The duration of surgery was 50 to 180 min,with an average of(110±8)min;bleeding volume was 20~280 mL,with an average of(50.0±5.5)mL;the postoperative hospital stay was 6 to 14 days,with an average of(9.7±1.2)days.There was no perioperative death,and there were 5 cases(11.6%)of postoperative complications,including 2 cases of hemoptysis,1 case of prolonged lung leakage,1 case of pulmonary infection,and 1 case of pleural effusion.All complications were cured.Conclusion Preoperative three-dimensional reconstruction can accurately understand the inner lung structure,accurately guide the surgery,and shorten the learning curve of the surgery of pulmonary segments,which makes thoracoscopic resection of pulmonary segments more accurate,safe,and feasible.

关 键 词：胸腔镜 解剖性肺段切除 三维重建 肺癌 

分 类 号：R655.3[医药卫生—外科学]