胸腔镜肺段切除术前采用3D-CTBA模拟对提高手术安全性和有效性的价值  

Value of simulation through 3D-CTBA before thoracoscopic pulmonary segmentectomy in improving surgical safety and reducing influence on lung function

作　　者：杨冉[1] 韩金利[2] 侯建彬[1] 耿明飞[1] YANG Ran;HAN Jinli;HOU Jianbin;GENG Mingfei(Department of Thoracic Surgery,Anyang Tumor Hospital,Anyang 455000,China)

机构地区：[1]安阳市肿瘤医院胸外科,河南安阳455000 [2]安阳市肿瘤医院检验科,河南安阳455000

出　　处：《安徽医学》2022年第3期289-294,共6页Anhui Medical Journal

基　　金：安阳市科技攻关计划项目(项目编号:20201537)。

摘　　要：目的探究胸腔镜肺段切除术前采用三维CT支气管血管成像(3D-CTBA)模拟对手术安全性和有效性的影响。方法选择安阳市肿瘤医院2018年6月至2020年7月期间收治的104例行胸腔镜肺段切除术的非小细胞肺癌(NSCLC)患者作为研究对象,使用随机数字表法分为模拟组和常规组,各52例,常规组行胸腔镜肺段切除术,模拟组在进行胸腔镜肺段切除术前行3D-CTBA模拟,比较两组患者临床疗效、手术切除情况、围术期指标、肺功能和手术并发症的差异。结果两组患者肺段切除部位多位于肺上叶及下叶背段,模拟组左、右肺肺段简单切除部位少于常规组,复杂切除部位多于常规组(P<0.05)。模拟组手术时间、胸腔引流管拔除时间、术后住院时间均短于常规组(P<0.05),术中出血量、术后引流量少于常规组(P<0.05),淋巴结清扫数多于常规组(P<0.05),闭合器使用数量差异无统计学意义(P>0.05)。术前两组患者用力肺活量(FVC)、一秒用力呼气容积(FEV_(1))、最大呼气峰值流速(PEF)、每分钟最大通气量(MVV)、肺一氧化碳弥散因子(TLCO)差异无统计学意义(P>0.05),术后模拟组FVC、FEV_(1)、MVV、TLCO高于常规组(P<0.05),两组PEF差异无统计学意义(P>0.05),术前术后的差值均低于常规组(P<0.05)。模拟组并发症总发生率(肺部感染、咯血、心律失常、肺漏气)低于常规组(P<0.05)。结论相较胸腔镜肺段切除术,术前采用3D-CTBA模拟可以提高NSCLC患者的手术安全性,减轻对肺功能的影响,且术后并发症较少。Objective To explore the value of simulation through three-dimensional computed tomography-bronchography and angiography(3D-CTBA)before thoracoscopic pulmonary segmentectomy in improving surgical safety and reducing the influence on lung function.Methods A total of 104 patients with non-small cell lung cancer(NSCLC)who underwent thoracoscopic pulmonary segmentectomy in Anyang Cancer Hospital between June 2018 and July 2020 were selected as the research subjects.They were divided into simulation group and conventional group by random number table method,with 52 cases in each group.Patients in the conventional group were directly treated with thoracoscopic pulmonary segmentectomy,while those in the simulation group underwent simulation through 3D-CTBA before thoracoscopic pulmonary segmentectomy.The clinical effects,surgical resection,perioperative indicators,lung function and surgical complications were compared between the two groups.Results The resection sites of the two groups focused on upper lobe and dorsal segment of the lower lobe.The simple resection sites of left and right lung segments in the simulation group were fewer than those in the conventional group,and complex resection sites were more than the conventional group(P<0.05).The operation time,chest tube removal time,and postoperative hospital stay of the simulation group were shorter than those of the conventional group(P<0.05).The intraoperative blood loss and postoperative drainage volume were less than those of the conventional group(P<0.05),and lymph nodes removed were more than those in the conventional group(P<0.05).There was no statistical difference in the number of closure devices used(P>0.05).There was no significant difference in forced vital capacity(FVC),forced expiratory volume in 1 second(FEV 1),peak expiratory flow(PEF),maximum ventilatory ventilation(MVV),and the lung for carbon monoxide(TLCO)between the two groups before surgery(P>0.05).After surgery,FVC,FEV 1,MVV and TLCO in the simulation group were higher than those in the conve

关 键 词：肺段切除术 胸腔镜 三维CT支气管血管成像 肺功能 安全性 

分 类 号：R734.2[医药卫生—肿瘤]