左肺上叶尖后段支气管新分型及其临床意义  

A new classification of left apicoposterior segmental bronchus and its clinical significance

作　　者：刘坚 魏立 祝李 胡帅 夏天 魏文学 LIU Jian;WEI Li;ZHU Li;HU Shuai;XIA Tian;WEI Wenxue(Department of Thoracic Surgery,Zhengzhou University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,450066,P.R.China)

机构地区：[1]郑州大学人民医院、河南省人民医院胸外科,郑州450066

出　　处：《中国胸心血管外科临床杂志》2024年第1期92-98,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的分析对左肺上叶尖后段支气管的一种新分型,并总结其临床意义。方法回顾性分析2021年1—11月河南省人民医院胸外科住院患者的影像资料,运用三维CT支气管血管成像(3D-CTBA)技术观察左肺上叶尖后段支气管(B1+2)的分支规律并对其进行分型。分析其中行胸腔镜下左肺上叶尖后段切除术患者的临床资料,探讨不同支气管分支类型对左肺上叶尖后段切除术精准、安全实施的指导意义。结果纳入患者240例,其中男131例、女109例,中位年龄51.0(19.0~77.0)岁。左肺上叶尖后段支气管可以根据外亚段支气管(B1+2c)的开口位置不同分为4种主要类型:Ⅰ型10%(24例),Ⅱ型54%(130例),Ⅲ型17%(40例),Ⅳ型18%(43例)和其他变异1%(3例)。32例患者顺利行左肺上叶尖后段切除术;Ⅰ型与Ⅱ型患者共23例,全部采用尖后段联合切除术式;Ⅲ型与Ⅳ型患者9例,其中3例采用尖后段联合切除术,4例采用LS1+2c切除术,2例采用LS1+2(a+b)切除术。结论本分型系统、简洁地阐明了左肺上叶尖后段支气管分支特点。不同分支类型对左肺上叶尖后段切除术的实施具有较好的指导意义。Objective To analyze a new classification of the left apicoposterior segmental bronchus and summarize its clinical significance.Methods We accessed the computed tomography imaging data of the inpatients treated in the Department of Thoracic Surgery,Henan Provincial People's Hospital between January and November 2021.We observed and classified the branching pattern of the left apicoposterior segmental bronchus(B1+2)using threedimensional computed tomography bronchography and angiography(3D-CTBA)technique.And we filtered out the patients who underwent thoracoscopic left apicoposterior segmentectomy and analyzed their clinical data retrospectively to summarize the instructing significance of different bronchial classification in the accurate and safe operation of left apicoposterior segmentectomy.Results Finally 240 patients were collected,including 131 males and 109 females with a median age of 51.0(19.0-77.0)years.The anatomical pattern of the left apicoposterior segmental bronchus was divided into four main types based on the branching pattern of the outer subsegmental bronchi(B1+2c):typeⅠ10%(24 patients),typeⅡ54%(130 patients),typeⅢ17%(40 patients),typeⅣ18%(43 patients)and other variations 1%(3 patients).Thirty-two patients smoothly underwent thoracoscopic left apicoposterior segmentectomy,including 23 patients of typeⅠand typeⅡreceiving LS1+2 resection,the other 9 patients of typeⅢand typeⅣreceiving LS1+2 resection(3 patients),LS1+2c resection(4 patients)and LS1+2(a+b)resection(2 patients).Conclusion This new classification systematically and concisely elucidates the branching characteristics of the left apicoposterior bronchus.Different branching types are instructive to the left apicoposterior segmentectomy.

关 键 词：尖后段支气管 解剖分型 外科手术 

分 类 号：R734.2[医药卫生—肿瘤]