摘要
目的探讨术前辅助定位联合CT三维重建技术在以肺结节为中心的单孔胸腔镜联合亚段/肺段切除术中的临床应用。方法回顾性分析2019年12月—2021年10月于首都医科大学宣武医院行联合亚段/肺段切除术30例患者的临床资料,其中男19例、女11例,平均年龄56.4(32.0~71.0)岁。术前应用CT引导下注射定位胶辅助定位肺结节,用Mimics 21.0软件三维重建技术做手术规划,术中根据定位胶的位置和CT三维重建图像行胸腔镜联合亚段/肺段切除术。结果全组患者均顺利完成手术,无中转开胸或肺叶切除。平均肿瘤直径(11.6±3.5)mm,平均结节距离脏层胸膜(13.6±5.6)mm,平均实际切缘宽度(25.0±6.5)mm,平均手术时间(110.2±23.8)min,平均淋巴结清扫站数(6.5±2.4)站,平均术中出血量(50.8±20.3)mL,平均胸腔引流管留置时间(3.2±1.1)d,平均术后住院时间(4.5±1.7)d。术后并发症包括皮下气肿1例、心房颤动1例、痰中带血1例。结论术前CT引导下注射医用胶辅助定位联合CT三维重建技术,在以肺结节为中心的单孔胸腔镜联合亚段/肺段切除术中安全可行,既保证了手术切缘,又最大限度地保留了肺组织,达到解剖学切除的目的。
Objective To assess the clinical value of preoperative localization coupled with computed tomography(CT)three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection.Methods The clinical data of 30 patients of combined subsegmental/segmental resection in our hospital from December 2019 to October 2021 were retrospectively collected.There were 19 males and 11females with the mean age of 56.4(32.0-71.0)years.The pulmonary nodules were located by CT-guided injection of glue before operation.The three-dimensional reconstruction image and operation planning were carried out by Mimics 21.0software.Results The operations were all successfully performed,and there was no conversion to open thoracotomy or lobectomy.The mean tumor diameter was 11.6±3.5 mm,the mean distance between the nodule and the visceral pleura was 13.6±5.6 mm,the mean width of the actual cutting edge was 25.0±6.5 mm,the mean operation time was 110.2±23.8 min,the mean number of lymph node dissection stations was 6.5±2.4,the mean amount of intraoperative bleeding was50.8±20.3 mL,the mean retention time of thoracic catheter was 3.2±1.1 d,and the mean postoperative hospital stay was 4.5±1.7 d.There was 1 patient of subcutaneous emphysema,1 patient of atrial fibrillation and 1 patient of blood in sputum.Conclusion Preoperative CT-guided injection of medical glue combined with CT three-dimensional reconstruction of pulmonary bronchus and blood vessels is safe and feasible in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection,which ensures the surgical margin and reserves lung tissues.
作者
王腾腾
刘宝东
张毅
苏雷
李元博
钱坤
WANG Tengteng;LIU Baodong;ZHANG Yi;SU Lei;LI Yuanbo;QIAN Kun(Department of Thoracic Surgery,Xuanwu Hospital,Capital Medical University,Beijing,100053,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2023年第3期364-368,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
术前辅助定位
三维重建
胸腔镜
联合亚段/肺段切除
Preoperative localization
three-dimensional reconstruction
thoracoscopy
combined subsegmental/segmental resection
