三维重建引导下胸腔镜扩大肺亚段切除术治疗肺段边缘结节

Three-dimensional Reconstruction Guided Thoracoscopic Extended Subsegmentectomy for Nodules Located at the Edge of Segment

目的探讨三维重建引导下胸腔镜扩大肺亚段切除术治疗肺段边缘结节的临床效果。方法对2018年8月~2021年1月采用胸腔镜扩大肺亚段切除术治疗25例肺段边缘结节的临床资料进行回顾性分析。术前薄层CT扫描并进行三维重建。肺段边缘结节共26枚,纯磨玻璃结节17枚,混合性磨玻璃结节9枚,直径4~15(8.0±2.5)mm。其中8例术前Hookwire定位。采用膨胀-萎陷法确定段平面。结果25例扩大肺亚段切除术共切除肺结节26枚,其中1例中转小切口辅助手术,切缘宽度均>2 cm或不小于结节直径。手术时间80~270(121.8±36.8)min,术后胸腔引流时间2~7(3.5±1.3)d,术后住院4~15(6.0±2.2)d。术后肺部感染1例,痰中带血3例,其中1例漏气>3天,无围手术期死亡。结论三维重建引导下胸腔镜扩大肺亚段切除术治疗肺段边缘结节安全可行,能充分保证切缘,最大化保留正常肺组织。

Objective To analyze the safety of three-dimensional(3D)reconstruction guided thoracoscopic extended subsegmentectomy(TESS)in the treatment of the nodules located at the edge of segment.Methods We retrospectively analyzed 25 patients with 26 nodules at the edge of segment who underwent TESS from August 2018 to January 2021.All the patients underwent thin-slice CT scanning and 3D reconstruction preoperatively.Among the 26 nodules,17 were pure ground glass nodules and 9 were mixed ground glass nodules,with a diameter of(8.0±2.5)mm(range,4-15 mm).Eight patients were given CT-guided hookwire localization preoperatively.The intersegmental plane was identified by inflation-deflation method.Results All the 26 nodules were resected with TESS in the 25 patients.One patient was converted to open thoractomy with small incision.The surgical margin width was greater than 20 mm or not less than the size of the nodule.The operative time was(121.8±36.8)min(range,80-270 min).The postoperative duration of chest tube placement was(3.5±1.3)d(range,2-7 d),and the postoperative hospital stay was(6.0±2.2)d(range,4-15 d).There were 1 patient with pulmonary infection and 3 patients with blood in sputum and one of them with air leakage over 3 days.No perioperative death was noted.Conclusion 3D reconstruction guided TESS is a safe and feasible technique in the treatment of the nodules located at the edge of segment,which can ensure sufficient surgical margins and maximize the preservation of normal lung tissue.