胸腔镜肺叶切除术前CT识别右中间段支气管背侧血管变异的临床价值  

Clinical value of CT identification of vascular variations on the dorsal side of right middle segmental bronchus before thoracoscopic lobectomy

作　　者：彭胜祖[1] 郑光华[1] 白军军 王彬[1] 张凯 杨斌[1] Peng Shengzu;Zheng Guanghua;Bai Junjun;Wang Bin;Zhang Kai;Yang Bin(Department of Thoracic Surgery,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院胸外科,太原030013

出　　处：《肿瘤研究与临床》2024年第10期743-746,共4页Cancer Research and Clinic

摘　　要：目的探讨术前CT识别右中间段支气管背侧血管变异在胸腔镜肺叶切除术中的临床价值。方法回顾性分析2022年7月至2024年3月于山西省肿瘤医院行胸腔镜肺叶切除术3例伴右中间段支气管背侧血管变异患者的临床资料,并复习相关文献。结果3例患者中,女性2例、男性1例,年龄分别为66、50、69岁。患者入院前影像学检查均发现右肺占位或结节,均行胸腔镜相应右肺叶切除术、系统性淋巴结清扫术,术后病理分别诊断为右肺下叶腺癌、右肺上叶囊性腺瘤、右肺下叶浸润性腺癌。术前阅读胸部CT片均发现右中间段支气管背侧一支异常血管,向下CT层面观察到其走向及汇入右下肺静脉或左心房,术中均得以证实并相应处理。3例患者术后均未发生并发症,恢复顺利,随访均健康状况良好。结论右中间段支气管背侧的血管变异在胸部CT上有明显的特征性表现。胸腔镜肺叶切除术前CT识别这一变异可有效保证手术安全,并减少术后并发症的发生。Objective To explore the clinical value of CT identification of vascular variations in the dorsal side of right middle segmental bronchus before thoracoscopic lobectomy.Methods A retrospective analysis was conducted on the clinical data of 3 patients who underwent thoracoscopic lobectomy at Shanxi Province Cancer Hospital from July 2022 to March 2024 and had a variant blood vessel on the dorsal side of the right middle segmental bronchus.Relevant literature was also reviewed.Results Among the 3 patients,2 were female and 1 was male,with ages of 66,50 and 69 years old,respectively.Prior to admission,imaging examinations revealed space-occupying lesions or nodes in the right lung,and all patients underwent thoracoscopic right lobectomy and systematic lymph node dissection.Postoperative pathology diagnosed adenocarcinoma in the lower lobe of the right lung,cystic adenoma in the upper lobe of the right lung and invasive adenocarcinoma in the lower lobe of the right lung.Preoperative chest CT scans revealed an abnormal blood vessel on the dorsal side of the right middle segmental bronchus,and its direction and confluence with the right lower pulmonary vein or left atrium were observed on the downward CT imaging.This was confirmed and treated accordingly during surgery.All 3 patients had no postoperative complications and recovered smoothly.Follow-up showed good health status.Conclusions The vascular variation on the dorsal side of the right middle segmental bronchus has obvious characteristic manifestations on chest CT.Identifying the variation by CT before thoracoscopic lobectomy can effectively ensure surgical safety and reduce the occurrence of postoperative complications.

关 键 词：肺切除术 肺静脉 胸腔镜检查 体层摄影术 X线计算机 

分 类 号：R734.2[医药卫生—肿瘤]