基于胸部CT检查图像的术前肋骨分型在胸腔镜胸交感神经切断术肋骨定位中的应用  

Application of preoperative rib classification based on chest CT imaging for rib localization in ETS

作　　者：许罡 胡超越 朱道龙 刘瀚 林园才 陈聪 汪栋 XU Gang;HU Chaoyue;ZHU Daolong;LIU Han;LIN Yuancai;CHEN Cong;WANG Dong(Department of Thoracic Surgery,Taikang Xianlin Gulou Hospital Affiliated to Nanjing University Medical School,Nanjing 210023,China)

机构地区：[1]南京大学医学院附属泰康仙林鼓楼医院胸外科,江苏南京210023

出　　处：《山东医药》2025年第3期26-29,共4页Shandong Medical Journal

基　　金：江苏省南京市卫生科技发展专项资金项目(YKK23260)。

摘　　要：目的基于胸部CT检查图像观察术前肋骨分型在胸腔镜胸交感神经切断术(ETS)肋骨定位中的应用效果。方法接受ETS手术治疗的原发性手汗症(PPH)患者1008例,术前进行胸部CT扫描。通过肋骨CT影像将患者分为三型:1型(肋骨常规型)754例、2型(胸顶可见第1肋型)31例、3型(第2肋隐约可见型)223例。ETS术中通过肉眼观察或移动式C臂X线机摄片验证术前肋骨分型准确性。结果1008例PPH患者均顺利完成ETS手术。1008例患者经术中肉眼观察或摄片检查后证实,术前肋骨分型均准确,术前肋骨分型正确率为100%。术前肋骨分型为1型的754例患者,经术中肉眼观察均确定肋骨分型为1型,术前肋骨分型均准确。术前肋骨分型为2型的31例患者,术中肉眼观察确定肋骨分型为2型者26例,术中肉眼观察不易分辨者5例,经术中摄片检查后确定为2型。术前肋骨分型为3型的223例患者,经术中肉眼观察确定肋骨分型为3型者204例,术中肉眼观察不易分辨者19例,经术中摄片检查后确定为3型。结论对于接受ETS手术治疗的PPH患者,基于胸部CT检查图像进行术前肋骨分型准确性高。Objective To evaluate the application effect of preoperative rib classification based on chest CT imaging for rib localization during endoscopic thoracic sympathectomy(ETS).Methods A total of 1,008 patients with primary palmar hyperhidrosis(PPH)undergoing ETS were enrolled.Preoperative chest CT scans were performed,and patients were classified into three rib types based on CT imaging:Type 1(normal rib anatomy,754 cases),Type 2(first rib visible at the thoracic apex,31 cases),and Type 3(second rib partially visible,223 cases).Intraoperative visual inspection or mobile C-arm X-ray imaging was used to verify the accuracy of preoperative rib classification.Results All 1,008 patients successfully underwent ETS.Intraoperative visual inspection or radiographic examination confirmed that the preoperative rib classification was accurate in all 1,008 cases,achieving a preoperative rib classification accuracy rate of 100%.Among the 754 patients preoperatively classified as Type 1,intraoperative visual inspection confirmed that all cases were Type 1,with no discrepancies.For the 31 patients preoperatively classified as Type 2,intraoperative visual inspection identified 26 cases as Type 2,while 5 cases were difficult to distinguish visually and were subsequently confirmed as Type 2 by intraoperative C-arm X-ray imaging.Among the 223 patients preoperatively classified as Type 3,intraoperative visual inspection identified 204 cases as Type 3,while 19 cases were difficult to distinguish visually and were confirmed as Type 3 after intraoperative radiographic examination.Conclusion For PPH patients who undergo ETS,preoperative rib classification based on chest CT imaging demonstrates high accuracy for rib localization.

关 键 词：胸腔镜手术 胸腔镜胸交感神经切断术 肋骨定位 肋骨分型 CT检查 原发性手汗症 

分 类 号：R61[医药卫生—外科学]