改良膨胀萎陷法界定肺段间交界面的精确性评估  

Assessment of the Accuracy of Modified Inflation-deflation Methods for Distinguishing the Intersegmental Border

作　　者：魏海星 朱燚宁 王琦[1] 陈亮[1] 吴卫兵[1] Haixing WEI;Yining ZHU;Qi WANG;Liang CHEN;Weibing WU(Department of Thoracic Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院胸外科,南京210029

出　　处：《中国肺癌杂志》2020年第6期526-531,共6页Chinese Journal of Lung Cancer

基　　金：江苏省“六大人才高峰”(No.WSW-028);江苏省“333工程”(No.BRA2017545);吴阶平医学基金会临床科研专项(No.320.2730.1868);江苏省人民医院“511腾飞工程”基金(No.JSPH-511B-2018-6)资助。

摘　　要：背景与目的对于早期肺癌,肺段切除术可以获得和肺叶切除术相同的肿瘤学疗效。肺段间交界面的精准界定是肺段手术的关键。本研究采用“改良膨胀萎陷法”行扩大肺段、亚段切除术治疗肺段间、亚段间磨玻璃结节(ground-glass nodules,GGN),评价“改良膨胀萎陷法”界定肺段交界面的精确性,和对扩大切除确保安全切缘宽度的有效性。方法回顾性分析本中心采用扩大肺段、亚段切除术治疗的患者83例。术前三维CT支气管血管成像(three-dimensional computed tomography bronchography and angiography,3D-CTBA)显示结节累及段间静脉。根据三维重建设计手术,扩大切除结节所属的优势肺段或亚段,无法确定优势肺段、亚段时,选择较为简单的肺段、亚段切除方式。术中切断靶段血管、支气管后采用“改良膨胀萎陷法”确定肺段间或亚段间交界面,应用切割缝合器距离膨胀萎陷交界线2 cm-3 cm扩大切除部分相邻肺段或亚段肺组织。观察标本中膨胀萎陷交界线与结节的关系,测量切缘宽度,收集围术期临床资料。结果实施扩大肺段切除术56例,扩大肺亚段切除术27例,肺结节平均直径(0.9±0.3)cm。出现清晰可辨膨胀萎陷交界线79例,交界线形成时间(13.6±6.5)min。解剖标本观察发现,结节累及膨胀萎陷交界线55例,其余24例结节距交界线的最小距离(0.6±0.3)cm,平均切缘宽度(2.1±0.3)cm。无术后30 d死亡和重大并发症。结论改良膨胀萎陷法可有效界定肺段间、亚段间交界面,以此为标准可确保扩大肺段、亚段切除术治疗段间、亚段间小肺癌的安全切缘。Background and objective For early-stage lung cancer,segmentectomy can get the same oncologi-cal benefits as lobectomy.Accurate identification of the intersegmental border is the key to segmentectomy.This study used extended segmentectomy and extended subsegmentectomy to treat lung intersegmental and intersubsegmental ground-glass nodules(GGN)by utilizing modified inflation-deflation methods to distinguish the intersegmental and intersub-segmental borders.The accuracy of modified inflation-deflation methods and the effectiveness of extended resection to guarantee a safe surgical margin were evaluated.Methods A retrospective analysis of 83 cases of extended segmentectomy and extended subsegmentectomy was conducted.Preoperative three-dimensional computed tomography bronchography and angiography(3D-CTBA)revealed that nodules were involved in intersegmental or intersubsegmental veins.Based on preoperative three-dimensional reconstruction,the surgery was designed to extendedly remove the dominant lung segment or subsegment with nodules involved.When the dominant lung segment or subsegment could not be identified,the simpler lung segment or subsegment was selected for the resection.After the target vessel and bronchus were cut off during the operation,modified inflation-deflation method was used to determine the border,and a stapler was used to resect the adja-cent lung segment or subsegment tissue by 2 cm-3 cm around the inflation-deflation boundary line.Then,the relationship between the inflation-deflation boundary line and the nodule and the width of the surgical margin were measured.Clinical data were collected during the perioperative period.Results 56 extended segmentectomies and 27 extended subsegmen-tectomies were performed.The average diameter of pulmonary nodules was(0.9±0.3)cm.There were 79 cases with clearly inflation-deflation boundary lines.The average time needed for the appearance of the lines was(13.6±6.5)min.In 55 cases,the nodules were involved with the inflation-deflation boundary lines.Meanwhile,

关 键 词：肺肿瘤 改良膨胀萎陷法 三维CT支气管血管成像 肺段切除术 扩大肺段切除术 

分 类 号：R734.2[医药卫生—肿瘤]