右上肺跨亚段动脉分型的单中心回顾性研究

Classification of trans-subsegmental artery in the right upper lobe:A retrospective study in a single center

目的分析右上肺肺段内及肺段间跨亚段动脉发生比例及分型,以提高右上肺亚段切除手术的精准性。方法回顾性分析2021年1月—2022年6月于南京医科大学第一附属医院胸外科行右上肺肺动脉造影检查患者的影像学资料。通过比对右上肺三维肺血管支气管重建及CT薄层肺窗,分析右上肺亚段级解剖,进一步细化跨亚段动脉类型。结果纳入111例患者,其中男36例、女75例,平均年龄(61.83±8.91)岁。右上肺跨亚段动脉共有29种类型,仅出现1次的类型比例为45%(13/29)。在S^(1)、S^(2)和S^(3)肺段内,跨亚段动脉比例分别为52%(58/111)、41%(45/111)和32%(36/111)。其中,比例最高类型为S^(1)内发自上干支动脉的A^(1)b+A^(1)at,占比67%(39/58)。S^(1)与S^(2)、S^(2)与S^(3)及S^(1)与S^(3)肺段间,跨亚段动脉比例分别为24%(27/111)、5%(5/111)及8%(9/111)。右上肺支气管共4种分型,在S^(1)、S^(2)、S^(3)肺段内,S^(1)与S^(2)、S^(2)与S^(3)、S^(1)与S^(3)肺段间,跨亚段动脉发生比例在不同支气管分型中差异均无统计学意义(P>0.05)。结论右上肺跨亚段动脉发生比例高,类型多样。肺段切除、肺亚段切除是极为个性化的手术过程。

Objective To improve the precision of subsegmentectomy,through analyzing the proportion and classification of the intrasegmental and intersegmental trans-subsegmental artery(TSA)in the right upper lobe.Methods The imaging data of the patients who underwent pulmonary angiography in the right upper lobe from January 2021 to June 2022 at the Department of Thoracic Surgery,the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed.The anatomy of subsegmental bronchi and arteries in the right upper lung was studied by comparing 3D CT bronchography and angiography and thin-section CT(lung window).The types of tans-subsegmental artery were further refined.Results Finally 111 patients were collected,including 36 males and 75 females with an average age of 61.83±8.91 years.There were 29 types of TSA in the right upper pulmonary artery,and 45%(13/29)of the types occurred only once.In the S^(1),S^(2),and S^(3) segments,the proportion of TSA was 52%(58/111),41%(45/111),and 32%(36/111),respectively.Among them,the type with the highest proportion was A1 b+A 1 at in S^(1),originating from the upper trunk artery,accounting for 67%(39/58).There were 24%(27/111),5%(5/111),and 8%(9/111)TSA between S^(1) and S^(2),S^(2) and S^(3),and S^(1) and S^(3),respectively.There were four types of bronchi in the right upper lobe.There was no statistical difference in the proportion of the intrasegmental and intersegmental TSA(P>0.05).Conclusion The TSA in the right upper lobe is common and has various types.Segmentectomy or subsegmentectomy is a highly personalized surgical procedure.