CT三维重建在肺小结节行胸腔镜肺段切除术中的应用  

Application of CT Three-dimensional Reconstruction in Thoracoscopic Pulmonary Segmental Resection of Pulmonary Nodules

作　　者：方燕红[1] 陈加优[1] 王枫[2] Fang Yanhong;Chen Jiayou;Wang Feng(Department of Radiology,Fujian Provincial Tumor Hospital(Fujian Medical University Affiliated Tumor Hospital),Fuzhou,Fujian 350014;Thoracic Surgery,Fujian Provincial Tumor Hospital(Fujian Medical University Affiliated Tumor Hospital),Fuzhou,Fujian 350014)

机构地区：[1]福建省肿瘤医院(福建医科大学附属肿瘤医院)放诊科,福建福州350014 [2]福建省肿瘤医院(福建医科大学附属肿瘤医院)胸外科,福建福州350014

出　　处：《现代医用影像学》2021年第2期215-218,共4页Modern Medical Imageology

基　　金：气管树、血管树三维重建在肺孤立性小结节中的应用,项目编号:2016-2-6。

摘　　要：目的:探讨术前使用CT三维成像技术重建肺支气管、肺动静脉、肺小结节在胸腔镜肺段切除术中的作用。方法:对2018年7月至2019年4月我院的40例拟行肺段切除的患者术前行CT增强扫描,然后三维重建出肺小结节、肺动静脉、支气管。通过三维重建图像进行多角度、多方位观察结节与支气管、肺动静脉的空间立体关系,进而模拟肺段切除方式,标定靶血管、靶支气管,术中按照重建图像进行精准肺段切除。结果:术前根据CT三维重建图像准确定位40例(100%),靶血管清晰显示38例(95%)、靶段支气管清晰显示37例(92.5%)。根据术前标注的靶血管、靶段支气管共施行右上肺分段切除17例,左上肺分段切除10例,双侧基底段分段切除4例,双侧背段分段切除9例。平均术中出血(67.25±51.39)ml,发生并发症5例,无死亡病例。结论:CT三维重建肺血管、支气管图像有助于肺小结节进行术前定位,可以清楚显示靶段支气管、靶血管,有助于外科进行胸腔镜肺段切除术。Objective:To investigate the role of preoperative CT three-dimensional reconstruction of pulmonary bronchus,pulmonary arteriovenous and pulmonary nodules in thoracoscopic pulmonary segmental resection.Methods:From July 2018 to April 2019,40 patients undergoing segmental pulmonary resection were examined by CT enhanced scan before operation,and then three-dimensional reconstruction of pulmonary nodules,pulmonary arteriovenous and bronchus was performed.The spatial stereoscopic relationship between nodules,bronchus and pulmonary arteries and veins was observed from multiple angles through three-dimensional reconstruction images,so as to simulate the resection of pulmonary segments and calibrate the target vessels and bronchi.Accurate lung resection was performed according to the reconstructed image during the operation.Results:Before operation,40 cases(100%)were accurately positioned according to the CT three-dimensional reconstruction image,38 cases(95%)were clearly displayed in the target vessel,and 37 cases(92.5%)were clearly displayed in the target bronchus.According to the target vessels and target bronchus marked before operation,there were 17 cases of right upper lung segmental resection,10 cases of left upper lung segmental resection,4 cases of bilateral basal segment resection and 9 cases of bilateraldorsal segment resection.The average intraoperative bleeding was(67.25±51.39)ml,with complications in 5 cases and no death.Conclusion:Ct three-dimensional reconstruction of pulmonary vessels,bronchial images are helpful to the preoperative localization of pulmonary nodules,can clearly show the target bronchus and target vessels,and is helpful for thoracoscopic pulmonary segmental resection.

关 键 词：CT三维成像 血管造影 胸腔镜 肺段切除术 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]