摘要
目的:探讨三维重建支气管、肺血管和肿瘤技术进行术前手术规划及术中实时导航对胸腔镜肺切除手术的临床应用价值。方法:回顾性分析非小细胞肺癌行胸腔镜肺叶根治性切除和肺结节行肺段切除术各25例病人的临床资料。所有病人术前均行胸部薄层CT扫描,应用DeepInsight软件对支气管、肺动脉、肺静脉进行重建,同时对肺部结节、肿瘤或者肿大淋巴结进行重建;通过术前重建三维图像进行精准的术前规划,特别是肺支气管及血管的变异情况,肿瘤、肿大淋巴结与肺血管的关系,肺结节在肺段中的精准定位等。对照术前三维重建,术中实时导航进行精准手术;记录术中有无中转开胸、手术时间、术中出血及术后住院时间、引流管拔除时间及总引流量,围术期并发症发生情况。结果:全部病人清晰重建支气管及肺血管解剖结构及变异情况,对中央型肿瘤及肿大淋巴结与血管的关系重建满意,明确定位肺结节在肺段中的位置及精确的进行术前规划。全部病人进行术中实时导航,按照术前规划实施精准手术,手术顺利完成,无中转开胸及术中意外出血情况,手术时间(147.60±37.77)min,术中出血量(33.82±22.17)mL,术后住院时间(7.02±1.78)d,引流管拔除时间(4.68±1.60)d,术后总引流量(221.00±135.03)mL;围术期无严重并发症及死亡病例。结论:应用胸部薄层CT数据进行术前三维重建及术中实时导航技术,能够精准、高效、安全方便的实施胸腔镜肺叶和肺段切除手术。
Objective:To explore the clinical value of the preoperative planning and intraoperative real-time navigation using the three-dimensional-reconstruction of bronchi,pulmonary vessels and tumors in thoracoscopic pneumonectomy.Methods:The clinical data of 25 non-small cell lung cancer patients treated with thoracoscopic radical lobectomy and 25 cases treated with segmental resection of pulmonary nodules were retrospectively analyzed.All patients were detected using chest thin-slice CT scan before operation,and the bronchus,pulmonary artery and pulmonary vein were reconstructed with DeepInsight software,and the pulmonary nodules,tumors or enlarged lymph nodes were also reconstructed.The accurate preoperative planning was carried out through the preoperative three-dimensional-reconstruction,especially the variation of pulmonary bronchus and blood vessels.The accurate operation were implemented using the real-time navigation of three-dimensional-reconstruction of tumors,enlarged lymph nodes and pulmonary vessels.The intraoperative conversion to thoracotomy,operation time,intraoperative bleeding and postoperative hospital stay,drainage tube removal time,total drainage volume and perioperative complications were recorded.Results:The anatomical structure,variation of bronchus and pulmonary vessels were clearly reconstructed in all patients,and the relationship between the central tumor,enlarged lymph nodes and vessels were satisfactory.The locatory of pulmonary nodules in the pulmonary segments was clearly identified,and the preoperative planning was accurately carried out.The intraoperative real-time navigation was carried out in all patients,and the precise surgery was carried out according to the preoperative plan.The operation was successfully completed,and no conversion to thoracotomy or intraoperative accidental bleeding were found.The operative time was(147.60±37.77)min,the intraoperative blood loss was(33.82±22.17)mL,the postoperative hospital stay was(7.02±1.78)d,the drainage tube removal time was(4.68±1.60)d,and the postoperative total drainage volume was(221.00±135.03)mL.There were not serious complications and death in perioperative period.Conclusions:The application of chest thin-slice CT data in preoperative three-dimensional-reconstruction and intraoperative navigation can accurately,effectively and safely guide the thoracoscopic lobectomy and pulmonary segmentectomy.
作者
李小军
张雷
唐震
朱潇
贡会源
王彪
杏福宝
高雄
LI Xiao-jun;ZHANG Lei;TANG Zhen;ZHU Xiao;GONG Hui-yuan;WANG Biao;XING Fu-bao;GAO Xiong(Department of Cardiothoracic Surgery,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004,China)
出处
《蚌埠医学院学报》
CAS
2020年第10期1363-1366,共4页
Journal of Bengbu Medical College
基金
蚌埠医学院转化医学重点专项(BYTM2019016,BYTM2019031)
安徽省教育厅自然科学研究重点项目(KJ2019A0340)
蚌埠医学院科技发展基金项目(BYKF1864)
蚌埠医学院第一附属医院高新技术项目(2019117)。
关键词
胸腔镜
三维重建技术
肺叶切除术
肺段切除术
thoracoscope
three-dimensional reconstruction
pulmonary lobectomy
segmentectomy