三维重建技术在胸腔镜解剖性肺段切除术中的应用

Application of Three-dimensional Computed Tomography Bronchography and Angiography in Thoracoscopic Anatomical Segmentectomy

目的探讨利用Mimics软件行三维计算机断层扫描支气管血管成像(three-dimensional computed tomography bronchography and angiography,3D-CTBA)在胸腔镜解剖性肺段切除手术中的应用价值。方法回顾性分析2016年9月～2018年5月行胸腔镜解剖性肺段切除手术48例,术前均利用Mimics软件行3D-CTBA显示手术肺段的解剖结构,判断有无肺段支气管、血管变异,决定术中所需切断的支气管及血管,制定手术方案。结果全组均在胸腔镜下顺利完成手术,术中情况与重建图像基本相符。手术时间(135.8±22.5) min,术中出血量(89.6±39.3) ml,术后胸管引流量(513.9±123.5) ml,术后胸管留置时间(2.9±1.3) d,术后住院日(6.1±1.2) d。术后无严重并发症发生。结论应用3D-CTBA行胸腔镜解剖性肺段切除手术安全有效,可以实现精准的肺段切除。

Objective To evaluate the feasibility and application value of three-dimensional computed tomography bronchography and angiography ( 3D-CTBA) using the Mimics software in thoracoscopic anatomical segmentectomy.Methods A total of 48 patients undergoing thoracoscopic anatomical segmentectomy from September 2016 to May 2018 in our department were retrospectively included in this study.All the patients underwent preoperative 3D-CTBA using the Mimics software to show the anatomy of pulmonary segments,find variations of the bronchi and blood vessels of lung,and make an operation plan including the bronchial and blood vessels to be amputated during the operation.Results All the operations of thoracoscopic segmentectomy were successfully performed without conversion to thoracotomy.The mean operation time was ( 135.8 ± 22.5) min.The mean blood loss was ( 89.6 ± 39.3) ml and the postoperative thoracic drainage was ( 513.9 ± 123.5) ml.The retention of chest tube time was ( 2.9 ± 1.3) d,and the average postoperative hospitalization was ( 6.1 ± 1.2 ) d.No serious complications occurred after the operation.Conclusion Application of 3D-CTBA in thoracoscopic anatomical segmentectomy is safe and effective,with accurate segmental resection achieved.