64排螺旋CT下的肺血管气管三维重建技术在肺段切除术中的应用

Application of Three-dimensional Reconstruction of Pulmonary Vessels and Trachea Under 64 Slice Spiral CT in Pulmonary Segmental Resection

目的:分析探讨64排螺旋CT对肺血管气管三维重建技术在肺段切除术的作用。方法:回顾性分析我院2019年11-2020年6月期间行肺段切除术,术前常规行肺血管、气管三维重建技术患者12位。经手术病理确诊的9例腺癌(7例微浸润性+2例浸润性腺癌),1例炎性假瘤,1例肺寡转移灶,1例不典型增生。比较术中肺段解剖与术前重建的结果一致性。结果:①64排螺旋CT对肺部血管气管三维重建技术对肺段血管辨识度高,术前重建和术中肺段解剖符合度高,可指导肺段切除术全组均顺利完成手术,手术顺利,无中转开放手术。结论:应用64排螺旋CT行三维肺血管支气管重建技术可对靶段血管、气管识别及其之间空间关系,与实际解剖符合度高。可了解手术安全切缘,设计合理的切除范围,对肺段的术前规划有指导意义。有利于手术操作,缩短手术时间。特别是利用医院现有条件,无需额外购买软件亦可完成肺段的术前重建,重建血管识别度高,与术中解剖符合率好,值得推广。

Objective:to analyze the role of 64 slice spiral CT in pulmonary vascular and tracheal three-dimensional reconstruction in pulmonary segmental resection.Methods:a retrospective analysis of our hospital from November 2019 to June 2020 during the period of segmentectomy,preoperative routine pulmonary vascular,tracheal three-dimensional reconstruction of 12 patients.Nine cases of adenocarcinoma(7 cases of microinvasive adenocarcinoma+2 cases of invasive adenocarcinoma),1 case of inflammatory pseudotumor,1 case of pulmonary oligometastasis,1 case of atypical hyperplasia were confirmed by operation and pathology.The consistency of the results between the intraoperative anatomy and preoperative reconstruction was compared.Results:①64 slice spiral CT three-dimensional reconstruction of pulmonary vessels and trachea has high recognition of pulmonary segmental vessels,high coincidence of preoperative reconstruction and intraoperative pulmonary segmental anatomy,which can guide pulmonary segmental resection.②all operations were successfully completed in the whole group,and the operation was smooth without conversion to open surgery.Conclusion:using 64 slice spiral CT in 3D reconstruction of pulmonary vessels and bronchi can identify the target vessels and trachea and their spatial relationship,which is in accordance with the actual anatomy.It can be used to understand the safe margin of the operation and design a reasonable resection range,which is of guiding significance to the preoperative planning of the lung segment.It is beneficial to the operation and shorten the operation time.In particular,using the existing conditions of the hospital,the reconstruction of the lung segment can be completed without additional purchase of software.The reconstruction vascular recognition is high,and the coincidence rate with intraoperative anatomy is good,which is worthy of promotion.