三维计算机断层扫描支气管血管成像联合荧光腔镜反染法在解剖性肺段切除术中的应用价值

Application Value of Three-dimensional Computed Tomography Bronchography and Angiography Combined With Fluoroscopic Reverse Staining Method in Anatomically Segmentectomy

目的探讨三维计算机断层扫描支气管血管成像(three-dimensional computed tomography bronchography and angiography,3D-CTBA)联合荧光腔镜反染法在解剖性肺段切除术中的应用价值。方法2020年1月~2021年1月对125例胸腔镜解剖性肺段切除术前使用三维重建软件Mimics Medical 21.0进行图像分析,通过容积渲染的方法生成3D-CTBA,术中通过外周静脉快速推注吲哚菁绿溶液,综合使用荧光导航内镜系统显示段间平面。结果125例均在3D-CTBA和荧光腔镜反染法联合应用下顺利完成手术,手术过程与术前模拟基本一致。手术时间60~350 min,中位数130 min;术中出血量10~400 ml,中位数20 ml。行优势肺段切除44例(35.2%),较为复杂肺段切除81例(64.8%)。段间平面显示效果:114例评为3级(段间线全部清晰显示),11例评为2级(段间线基本全部清晰显示),无一例出现不能完成段间平面标记的情况,且吲哚菁绿溶液注入未见不良反应。结论在术前良好的3D-CTBA基础上,联合术中荧光腔镜反染法可以很好地实现解剖性肺段切除术,值得临床推广应用。

Objective To evaluate the application value of the combination of three-dimensional computed tomography bronchography and angiography(3D-CTBA)and intraoperative indocyanine green(ICG)reverse staining method in anatomically segmentectomy.Methods A total of 125 patients treated with thoracoscopic segmentectomy from January 2020 to January 2021 were enrolled.The 3D reconstruction software Mimics Medical 21.0 was used for image analysis before operation,and 3D-CTBA was generated by volume rendering.ICG solution was rapidly injected through peripheral vein during the operation,and the fluorescence navigation endoscopic system was used to display the intersegmental plane.Results The operations were smoothly completed with 3D-CTBA combined with fluoroscopic method in all the patients,which were almost identical to preoperative simulations.The operation time was 60-350 min(median,130 min)and the blood loss was 10-400 ml(median,20 ml).Dominant segmental resection was performed in 44 cases(35.2%)and complicated segmental resection in 81 cases(64.8%).The intersegmental plane displayed 114 cases rated as grade 3(all intersegmental lines were clearly displayed)and 11 cases rated as grade 2(all intersegmental lines were basically clearly displayed).No case failed to complete the intersegmental plane marking,and no adverse reaction was found after ICG solution was injected.Conclusion On the basis of good preoperative 3D-CTBA images,ICG reverse staining method helps achieve anatomic resection and deserves clinical promotion and application.