Thoracoscopic segmentectomy and lobectomy assisted by threedimensional computed-tomography bronchography and angiography for the treatment of primary lung cancer  

作　　者：Yun-Jiang Wu Qing-Tong Shi Yong Zhang Ya-Li Wang 

机构地区：[1]Department of Thoracic Surgery,The Affiliated Hospital of Yangzhou University,Yangzhou University,Yangzhou 225009,Jiangsu Province,China [2]Department of Radiology,The Affiliated Hospital of Yangzhou University,Yangzhou University,Yangzhou 225009,Jiangsu Province,China [3]Department of Respiratory Medicine,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China

出　　处：《World Journal of Clinical Cases》2021年第34期10494-10506,共13页世界临床病例杂志

基　　金：National Natural Science Foundation of China,No.81800050;Natural Science Fund of Yangzhou City,No.YZ2017119;Science and Technology Innovation Cultivation Program of Yangzhou University,No.2017CXJ122.

摘　　要：BACKGROUND Anatomical segmentectomy has been proposed as a substitution for lobectomy for early-stage lung cancer.However,it requires technical meticulousness due to the complex anatomical variations of segmental vessels and bronchi.AIM To assess the safety and feasibility of three-dimensional computed-tomography bronchography and angiography(3D-CTBA)in performing video-assisted thoracoscopic surgery(VATS)for lung cancers.METHODS In this study,we enrolled 123 patients who consented to undergo thoracoscopic segmentectomy and lobectomy assisted by 3D-CTBA between May 2017 and June 2019.The image data of enhanced computed tomography(CT)scans was reconstructed three-dimensionally by the Mimics software.The results of preoperative 3D-CTBA,in combination with intraoperative navigation,guided the surgery.RESULTS A total of 59 women and 64 men were enrolled,of whom 57(46.3%)underwent segmentectomy and 66(53.7%)underwent lobectomy.The majority of tumor appearance on CT was part-solid ground-glass nodule(pGGN;55.3%).The mean duration of chest tube placement was 3.5±1.6 d,and the average length of postoperative hospital stay was 6.8±1.8 d.Surgical complications included one case of pneumonia and four cases of prolonged air leak lasting>5 d.Notably,there was no intraoperative massive hemorrhage,postoperative intensive-care unit stay,or 30-d mortality.Preoperative 3D-CTBA images can display clearly and vividly the targeted structure and the variations of vessels and bronchi.To reduce the risk of locoregional recurrence,the application of 3D-CTBA with a virtual 3D surgical margin help the VATS surgeon determine accurate distances and positional relations among the tumor,bronchial trees,and the intersegmental vessels.Three-dimensional navigation was performed to confirm the segmental structure,precisely cut off the targeted segment,and avoid intersegmental veins injury.CONCLUSION VATS and 3D-CTBA worked in harmony in our study.This combination also provided a new pattern of transition from lesion-directed location of tumors t

关 键 词：THORACOSCOPY SEGMENTECTOMY LOBECTOMY Three-dimensional computed tomography Bronchography and angiography 

分 类 号：R734.2[医药卫生—肿瘤]