3D数字肺软件在低肺功能储备的多发肺内小结节手术规划中的运用

Application of 3D Digital Lung Software in Preoperative Planning of Patients with Multiple Pulmonary Nodules and Poor Pulmonary Function

目的 评估3D数字肺软件应用于低肺功能储备合并多发肺内小结节患者胸腔镜下同期多肺段切除术术前规划的可行性。方法 纳入我院2015年6~12月既往有右肺单一肺叶切除史,左肺多发肺内结节的5例患者,其中男4例,女1例;平均年龄（50.4±2.6）岁。术前采用320排CT的超薄层扫描做肺动脉血管造影（computed tomography angiography,CTA）,CT图像数据导入厦门强本科技有限公司自主研发的3D数字肺软件进行三维重建,并以肺动脉系统为基础进行肺段自动划分,对肺内结节进行三维重建。3D数字肺软件计算拟切除的病变肺段占全肺的体积比例,估算手术对第1秒用力肺活量（FEV1）的影响,评估患者对手术的耐受性。做好手术前规划后,在全身麻醉下行胸腔镜下同期多肺段/亚段切除术。结果 5例患者的肺动脉三维重建均能达到5级以下分支水平,并自动划分出肺段,清楚显示肺内结节所在肺段/亚段。5例预切除肺体积占全肺体积14.00%～27.00%。估算术后FEV1为1.16～1.46 L,能耐受手术。5例均顺利施行胸腔镜下肺段/亚段切除术,术中切下肺段立即解剖找到肺内结节,并送快速病理检查明确诊断。术后患者恢复顺利,无呼吸功能不全表现,术后住院时间4 d。结论 3D数字肺软件不但可以自动划分肺段,精确定位肺内结节位置,显示目标肺段动静脉、支气管与周围动静脉、支气管的关系,还能计算病变肺段的体积,估算手术对FEV1的影响,帮助术前最准确的、量化的评估多发肺内结节患者对同期多肺段切除术的耐受性。

Objective To assess the feasibility of 3D digital lung software used in preoperative planning of patients with multiple pulmonary nodules and poor pulmonary function. Methods Five patients with multiple pulmonary nodules in the left lung, meanwhile with a history of single lung lobectomy in the right lung were included in our hospital between June and December 2015. There were 4 males and 1 female at an average age of 50.4±2.6 years. A 320-slice volumetric CT scanner was used to the CT angiography （CTA） of the pulmonary artery. The data of CT images were imported into the 3D digital lung software that was researched and developed by Xiamen QiangBen Science and Technology Company. The 3D reconstruction of digital virtual lung was completed by this software based on those data. At the same time the soft- ware completed the automatic segmentation of the lung based on the pulmonary artery system and the 3D reconstruction of the pulmonary nodules. The 3D digital lung software calculated the volume proportion of the intended removal （segm- ental lesions） to the whole lung, estimated the effect of surgery on forced expired volume in one second （FEV1）, and the patient＇s tolerance ability to surgery. After the preoperative planning, the patients received multiple pulmonary segmental/ subsegmental resection under the general anesthesia by video-assisted thoracoscopic surgery （VATS）. Results The 3D reconstruction of the pulmonary arteries reached 5 levels in 5 patients. And the software automatically identified out the lung segment/subsegment to show the lung nodules of lung segment/subsegment. The preselection lung volume of 5 patients accounted for 14.00%-27.00% of total lung volume. The software estimated FEVI as 1.16-1.46 L which can tolerate the operation. The 5 patients were successfully performed surgery of multiple pulmonary segmental/subsegmental resection under the general anesthesia by VATS. The software located lung nodules from the resection of pulmonary segments during operation immediately. Then we sent them to the rapid pathological examination for diagnosis. After operation, the patients recovered well, and had no respiratory insufficiency. Hospitalization day was 4 days. Conclusion The 3D digital pulmonary software can not only automatically identify the pulmonary segments, precisely position the pulmonary nodule, show the relationship among the target pulmonary segments artery, vein, bronchus and the surroun- ding artery, vein, and bronchus, but also calculate the volume of the pulmonary segments, estimate the impact of the pulmonary segmentectomy on the FEVI. It is useful for precise evaluation of the tolerant capacity of multiple pulmonary nodules in patients with unstaged multiple pulmonary segments.