三维CT支气管血管成像在机器人肺段切除术中的临床应用

Clinical application of three-dimensional computed tomography bronchography and angiography in robotic lung segmentectomy

目的探讨三维CT支气管血管成像(3D-CTBA)在机器人解剖性肺段切除术中的临床应用价值。方法采用非随机同期对照研究方法,连续纳入我科2019年1月至2020年1月行机器人解剖性肺段切除术122例患者,根据术前是否行3D-CTBA分为重建组[53例,男18例,女35例,中位年龄52(26~69)岁]和传统组[69例,男23例,女46例,中位年龄48(30~76)岁]。比较分析两组患者的临床资料。结果两组患者均顺利完成手术,无围术期死亡等严重并发症,顺利康复出院。两组患者基线资料差异无统计学意义(P>0.05),具有可比性。两组患者手术时间[120(70~185)min vs.120(45~225)min,P=0.801]、术中出血量[50(20~300)mL vs.30(20~400)mL,P=0.778]、围术期并发症发生率(17.0%vs.11.6%,P=0.162)、术后住院时间[7(4~19)d vs.7(3~20)d,P=0.388]差异均无统计学意义。但重建组有5例(9.4%)术中未找到结节,仅1例(1.9%)需要行扩大肺叶切除术,4例根据重建结果结束手术,术后标本固定后找到结节;而传统组有8例(11.6%)术中未找到结节并行扩大切除术,差异具有统计学意义(P<0.05)。术后中位随访时间10(1~26)个月,无复发转移以及死亡病例。结论3DCTBA有助于肺结节精准定位及合理手术规划,从而减少误切,且不会延长手术时间、增加术中出血量以及术后并发症等,临床应用于解剖性肺段切除术安全有效。

Objective To explore the clinical value of three-dimensional computed tomography bronchography and angiography(3D-CTBA)in robotic lung segmentectomy.Methods A non-randomized control study was performed and continuously enrolled 122 patients who underwent robotic lung segmentectomy in our hospital from January 2019 to January 2020.3D-CTBA was performed before operations in 53 patients[a 3D-CTBA group,including 18 males,35 females,with a median age of 52(26-69)years]and not performed in the other 69 patients[a traditional group,including 23 males,46 females,with a median age of 48(30-76)years].The clinical data of the patients were compared between the two groups.Results All the patients were successfully completed the surgery and recovered from hospital,with no perioperative death.The baseline characteristics of the patients were not significantly different between the two groups(P>0.05).No significant difference was found in the operative time[120(70-185)min vs.120(45-225)min,P=0.801],blood loss[50(20-300)mL vs.30(20-400)mL,P=0.778],complications rate(17.0%vs.11.6%,P=0.162),postoperative hospital stay[7(4-19)d vs.7(3-20)d,P=0.388]between the two groups.In the 3D-CTBA group,5(9.4%)patients did not find nodules after segmentectomy,and only 1(1.9%)of them needed lobectomy,but in the traditional group,8(11.6%)patients did not find nodules and had to carry out lobectomy,the difference was statistically significant(P<0.05).The follow-up time was 10(1-26)months,and during this period,there was no recurrence,metastasis or death in the two groups.Conclusion 3D-CTBA is helpful for accurate localization of nodules and reasonable surgical planning before operations,and reducing wrong resections in segmentectomy,without increasing the operation time,blood loss and complications.It is safe and effective in anatomical lung segmentectomy.