单孔荧光胸腔镜结合EDDA-IQQA三维重建软件在复杂肺段切除中的临床应用

Clinical application of single-hole fluorescence thoracoscopy combined with EDDA-IQQA three-dimensional reconstruction software in complex pulmonary segment resection

目的探讨单孔荧光胸腔镜结合三维重建软件EDDA-IQQA在复杂肺段切除手术中的应用。方法收集215例在南京市胸科医院胸外科行肺段切除术的患者资料,包括术前行支气管检查、肺血管的三维重建数据,术中数据及术后并发症情况进行分析,所有患者手术方式均为拟单孔胸腔镜手术,手术中应用三维重建软件EDDA-IQQA荧光法界定段间平面后行肺段切除术。结果215例手术均顺利完成,未增加操作孔,无改变手术方式,平均手术时间79.73±30.14 min,术中出血量25.88±30.24 mL,术后胸管留置时间4.14±0.68 d,术后有10例出现痰中带血,口服云南白药一周后好转,8例出现短暂肺漏气(<4天),心律失常2例,肺部感染2例,无术后30天死亡病例。结论EDDA-IQQA三维重建软件为开展肺段,特别是复杂联合亚肺段切除提供了方便、有效的导航,同时,荧光法可以快速、准确、清晰地显示段间线,两者之间的完美结合可以降低复杂肺段的难度和风险,缩短学习曲线,是一种安全有效的方法,值得临床推广应用。

Objective To explore the application experience of single-hole fluorescence thoracoscopy combined with three-dimensional reconstruction software EDDA-IQQA in complex segmental resection.Methods The data of 215 patients undergoing pulmonary segmentectomy in Nanjing Chest Hospital were collected.Three-dimensional reconstruction of bronchi and pulmonary vessels was performed before surgery.Single-hole thoracoscopy was performed during the operation.The intersegment plane was defined by fluorescence method.Pneumonectomy was performed later,and intraoperative data and postoperative complications were collected for analysis.Results All 215 operations were successfully completed without adding operation holes and no change in surgical method.The average operation time was 79.73±30.14 min,the intraoperative blood loss was 25.88±30.24 mL,and the postoperative chest tube indwelling time was 4.14±0.68 d.10 patients developed blood in the sputum,which improved after one week of oral administration of Yunnan Baiyao.8 patients developed transient pulmonary air leaks(<4 days),2 cases had arrhythmia,2 cases had pulmonary infections,and no death occurred 30 days after surgery.Conclusion The EDDA-IQQA three-dimensional reconstruction software can provide convenient and effective navigation for developing lung segments,especially complex combined subpulmonary resections.At the same time,the fluorescence method can quickly,accurately,and clearly show the segments compared to the traditional dilated and collapsed method.Interline,the perfect combination between the two can significantly shorten the operation time,which is a safe and effective method and worthy of clinical promotion and application.