肺动脉切除重建术的应用解剖学

Applied anatomy of resection and reconstruction of pulmonary artery

目的:为肺动脉切除与重建提供解剖学基础。方法:选择肺内结节性病灶,直径<3.0cm的周围型肺癌或良性球灶,接受肺叶切除手术的病人,对其肺动脉心包外段的长度、外径、分支及奇静脉各段的长度、外径进行观测。结果:左、右肺动脉出心包返折处至下叶背支动脉起点处的长度分别约为45.7mm、42.8mm;动脉起点处的外径:左侧分别为20.6mm、12.6mm,右侧分别为21.5mm、14.7mm。奇静脉可利用的第1段(奇静脉弓)和第2段的长度分别为44.8mm、46.8mm,第1段两端的外径分别为12.7mm、12.3mm。结论:肿瘤侵犯肺动脉主干及其分支根部,动脉切除后可采用侧壁扩大及袖式吻合重建术。肺动脉侧壁切除缺损较大时,右侧可首选自体奇静脉片;左侧首选心包片进行重建。

Objective: To provide the anatomical basis for resection and reconstruction of pulmonary artery (PA). Methods: Forty adult patients, who suffered from peripheral small malignant or benign pulmonary nodules (less than 3.0 cm in diameter), underwent lung lobectomy. The length and external diameter of bilateral extrapericardial PA were observed and measured in 20 patients. Meanwhile, observation and measurement of the length and external diameter of azygos vein were made in the right thoracotomy. Results: The distance between the reflection point of PA and the origin of superior branch of inferior lobe was about 45.7 mm on the left side and 42.8 mm on the right side. The external diameters at the reflection point of PA and at the origin of superior branch of lower lobe were 20.6 mm, 12.6 mm on the left side respectively, and 21.5 mm, 14.7 mm on the right side respectively. The length of the first segment (azygos vein arch) and second segment of azygos vein were 44.8 mm and 46.8 mm respectively. The external diameter of the both ends of first part of azygos vein were 12.7 mm and 12.3 mm respectively. Conclusion: PA can be reconstructed with lateral wall enlargement and sleeve anastomosis when the lung carcinoma infiltrating the trunk or the root of branches of PA. Autologus azygos vein patch and autologus pericardium patch can be used to reconstruct the right or left PA if its lateral wall absence is larger.