术前三维重建指导下两种手术方式治疗肺段间结节的效果比较

目的比较在术前三维重建的指导下肺联合亚段切除和扩大肺段切除两种术式治疗肺段间结节的优缺点。方法回顾性分析2019年1月至2021年6月行肺段间结节手术治疗的患者,其中联合亚段切除术(Combined Subsegmentectomy,CSS)31例和扩大肺段切除术(Extended Segmentectomy,ES)30例,所有患者术前均完善胸部薄层CT及进行图像显示清晰的三维重建,比较两组患者围术期资料。结果两组患者术中出血量、相关淋巴结清扫数量、术中及术后严重并发症、术后带管时间、中转开胸率差异无统计学意义(P>0.05)。CSS组术后咳血、肺复张不良、肺漏气、肺部感染等并发症发生率明显低于ES组(P<0.05),CSS组切缘宽度、手术时间长于ES组(P<0.05)。结论三维重建指导下肺联合亚段切除术治疗肺段间结节比传统扩大肺段切除术效果更好,能保留更多正常肺组织,更利于患者肺功能的恢复,值得在临床推广。

Objective To compare the advantages and disadvantages of combined subsegmental resection and extended segmental resection for pulmonary nodules under the guidance of preoperative three-dimensional reconstruction.Methods A retrospective analysis was performed on patients who underwent surgery for intersegmental pulmonary nodules from January 2019 to June 2021 in the Department of Thoracic Surgery of the Second Affiliated Hospital of Anhui Medical University including Combined Sub segmentectomy(CSS)(31 cases)and Extended Segmentectomy(ES)(30 cases).All patients underwent preoperative chest thin slice CT and 3d reconstruction with clear image display.Perioperative data of the two groups were compared.Results There were no significant differences in perioperative indicators between the two groups,such as intraoperative blood loss,number of lymph node dissection,serious complications,postoperative catheter time and conversion rate of thoracotomy(P>0.05).The incidence of postoperative complications such as hemoptysis,poor pulmonary re-expansion,lung leakage and pulmonary infection in the CSS group was significantly lower than that in the ES group(P<0.05),and the margin width and operation time in the CSS group were significantly longer than that in the ES group(P<0.05).Conclusion Combined subsegmental pulmonary resection guided by three-dimensional reconstruction has better effect than traditional extended segmental pulmonary resection in the treatment of intersegmental pulmonary nodules,and can preserve more normal lung tissue,and is more conducive to the recovery of lung function of patients,which is worthy of clinical promotion.