Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: A report of 52 consecutive cases
Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: A report of 52 consecutive cases
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DOI：
10.1016/j.jtcvs.2010.08.027
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发表时间：
2011-03-01
影响因子：
6
通讯作者：
Sadahiro, Mitsuaki
中科院分区：
文献类型：
--
作者：
Oizumi, Hiroyuki;Kanauchi, Naoki;Sadahiro, Mitsuaki
目的：本回顾性研究的目的是评价三维多探测器计算机断层扫描模拟指导下解剖胸腔镜肺段切除术的疗效。方法：2004年9月至2009年6月，52例患者（中位年龄68岁，范围16-85岁）行胸腔镜下无小开胸节段切除术。图像通过64通道多探测器计算机断层扫描和造影剂获得。肺动静脉结构的确定主要采用三维体绘制方法。在研究的初始阶段进行术前模拟，在后期进行术中模拟。利用模拟图像识别病变节段内的静脉分支进行分割，保留节段间静脉。使用了4个5- 20mm端口。通过分离肺动脉和支气管进行节段切除术，然后沿节段间平面剥离。结果：51例患者行胸腔镜下全节段切除术。1例因动脉出血行小开胸术。全胸腔镜下肺段切除术的成功率为98%。根据手术难易程度将手术分为3类。在引入模拟之前，有4个简单的情况和1个相当困难的情况。引入术前模拟后，12例节段切除术中有7例手术难度较大。并对7例困难节段切除术进行术中模拟。随访期间无局部复发转移及死亡。结论：三维多探测器计算机断层扫描模拟下胸腔镜肺段切除术是一种安全的技术。[J] .中华胸心外科杂志，2011;41:678-82。
Objective: The purpose of this retrospective study was to evaluate the efficacy of anatomic thoracoscopic pulmonary segmentectomy performed under the guidance of 3-dimensional multidetector computed tomography simulation.Methods: Between September 2004 and June 2009, 52 patients (median age, 68 years; range, 16-85 years) underwent thoracoscopic segmentectomy without mini-thoracotomy. Images were obtained by using 64-channel multidetector computed tomography and a contrast agent. The pulmonary arteriovenous structure was mainly determined using a 3-dimensional volume-rendering method. The preoperative simulation was performed at the initial stage of the study and the intraoperative at a later stage. The simulated images were used to identify the venous branches in the affected segment for division and the intersegmental veins to be preserved. Four 5- to 20-mm ports were used. Segmentectomy was performed by separating the pulmonary arteries and bronchi followed by dissection along the intersegmental plane.Results: Fifty-one patients underwent a complete thoracoscopic segmentectomy. A mini-thoracotomy was performed in 1 case because of arterial bleeding. The success rate of segmentectomies under complete thoracoscopy was 98%. The procedure was classified into 3 categories according to the degree of surgical difficulty. Before introducing the simulation, there were 4 easy cases and 1 fairly difficult case. After introducing preoperative simulation, 7 cases were classified as fairly difficult among 12 segmentectomy cases. Furthermore, 7 cases of difficult segmentectomy were performed using intraoperative simulation. No local recurrence or metastasis and no mortality were observed during the follow-up.Conclusions: Thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation is a safe technique. (J Thorac Cardiovasc Surg 2011;141:678-82)