三维肺支气管血管重建模拟手术在胸腔镜肺段切除治疗早期肺癌中的应用

The application of virtual segmentectomy based on three-dimensional computed tomography bronchography and angiography in thoracoscopic segmentectomy for early-stage lung cancer

目的探讨三维肺支气管重建模拟手术在胸腔镜肺段切除治疗早期肺癌的应用。方法拟行全胸腔镜肺段切除术的病人18例,进行三维肺支气管血管重建和模拟手术,根据结果规划手术方案。结果全组均顺利完成手术,手术时间(126.8±19.4)分钟,出血量(76.6±21.4)ml,无中转开放手术。其中右S1切除1例,右S3切除2例,右S6切除3例,右S8+9切除1例,右S9+10切除1例,左S1+2+3切除3例,左S4+5切除3例,左S6切除4例。所有标本切缘均未见肿瘤残留,所有淋巴结均未见肿瘤转移。实际切缘宽度均>2 cm,平均(2.37±0.39)cm。结论基于三维肺血管支气管重建的模拟手术可无创了解安全切缘与相应肺血管、支气管的关系,设计合理的切除范围,对规划早期肺癌的手术方案具有指导意义。

Objective To study the clinical value of virtual segmentectomy based on three-di-mensional computed tomography bmnchography and angiography（3 D-CTBA）in thoracoseopic segaentee-tomy for early-stage lung cancer.Methods Totally 18 patients received thoracoscopic segraentectomy from July 2015 to July 2016 were performed virtual segmentectomy based on 3D-CTBA.The preoperative planning depended on the simulation result.Results All of the 18 eases（1 fight S1,2 right S3,3 right S6,1 right S8 ＋ 9,1 right S9 ＋ 10,3 left S1 ＋ 2 ＋ 3,3 leftS4 ＋ 5,4 left S6 segmentectomies）were received thoraeoscopic segrnentectomy successfully.The mean operation time and intraoperative blood loss were（126.8 ±19.4）mins and（76.6±21.4）ml respectively.Pathological examination revealed no residual tumor cells at the surgical margins and no lymph node metastases in any patients.The actual surgical mar-gins were all larger than 2 cm（2.37±0.39）cm.Conclusion Virtual segmentectomy based on 3 D-CTBA can non-invasively visualize the relationship between the safe margin and segmental vessels and bronchi.It facilitates the preoperative planning of suitable segmentectomy procedure for patients with early-stage lung cancer.