基于337例CT数据的纵隔型舌段动脉3D分型临床应用

Clinical application of 3D classification of mediastinal lingual artery based on 337 CT images raw data

目的探讨3D纵隔型舌段动脉(MLA)分型在肺段术前规划中的作用。方法回顾性分析2019-01-01-2019-06-30南京医科大学第一附属医院胸外科337例连续行左肺上叶、段及亚段切除患者的胸部薄层CT资料(≤1 mm),使用Deepinsight3D软件根据标准步骤重建左肺上叶支气管及动静脉,分析亚舌段动脉变异频率、起源动脉位置以及走行模式。结果MLA总存在率为29.38%(99/337),分为9个类型。TypeⅠ(双亚段A4+A5)30例,占8.90%;TypeⅡ(单亚段A4)42例,占12.46%;TypeⅢ(单亚段A4b)11例,占3.26%;TypeⅣ(单亚段A5)8例,占2.37%;TypeⅧ(双亚段A5+A4b)4例,占1.19%;TypeⅤ(单亚段A5a)、Ⅵ(双亚段A4+A5a)、Ⅶ(双亚段A4+A5b)、Ⅸ(双亚段A4b+A5a)各1例,分别占0.30%。在胸部CT横断面隆突层面上的上肺静脉和支气管间隙容易辨认MLA的起始段,通过动态薄层增强CT能辨认MLA分型。结论本研究描述了术前3D影像MLA分型以及MLA在胸部CT横断面上的特征性表现;Deepinsight软件术前三维重建对肺段术前规划有重要指导意义。

Objective To investigate the role of 3 D mediastinal lingual artery(MLA) classification in preoperative planning of pulmonary segment.Methods The chest thin-slice high-resolution CT data(≤ 1 mm) of 337 consecutive patients with left upper lobe,segment and subsegment resection in the Department of Thoracic Surgery of the First Affiliated Hospital of Nanjing Medical University from January 1 to June 30,2019 was analyzed retrospectively.The bronchus,arteries and veins of the left upper lobe were reconstructed according to the standard steps by using deepinsight 3 D software,and the variation frequency,origin artery location and walking mode of the sublingual artery were analyzed.Results MLA as the most common aberrant branch of the left upper pulmonary artery vessels was identified in 99 cases(29.38%) using 3 DCT.All MLAs were classified into 9 types:2 subsegments A4+A5 was Type Ⅰ ascertained 30 patients(8.90%);1 subsegment A4 was Type Ⅱ ascertained 42 patients(12.46%);1 subsegment A4 b was Type Ⅲ ascertained 11 patients(3.26%);1 subsegment A5 was Type Ⅳ ascertained 8 patients(2.37%);2 subsegments A5+A4 b was Type Ⅷ ascertained 4 patients(1.19%);1 subsegment A5 a(Type Ⅴ),2 subsegments A4+A5 a(Type Ⅵ) and A4+A5 b(Type Ⅶ) and A4 b+A5 a(Type Ⅸ) were ascertained 1 patients(0.30%) separately.MLA origin was identified descending between the upper pulmonary vein and upper bronchus in successive chest-computed thin-slice tomography and MLA types by companying artery branch.Conclusions MLA types can be classified to facilitate anatomical segmentectomy and identified in dynamic chest-computed thin-slice tomography.3 DCT soft could play an important role in safe and efficient video-assisted thoracic surgery anatomical resection.