Methylene Blue Staining: A New Technique for Identifying Intersegmental Planes in Anatomic Segmentectomy
Methylene Blue Staining: A New Technique for Identifying Intersegmental Planes in Anatomic Segmentectomy
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DOI：
10.1016/j.athoracsur.2014.07.071
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发表时间：
2015-01-01
影响因子：
4.6
通讯作者：
Liu, Changyu
中科院分区：
文献类型：
--
作者：
Zhang, Zheng;Liao, Yongde;Liu, Changyu
背景肺段切除术越来越多地用于切除小的肺结节，然而，识别肺段间平面是困难的。我们描述了一种新的美蓝染色技术，我们开发的视频辅助胸外科手术（VATS）或开胸手术，以确定解剖节段切除术中的节间平面，并评估其可行性和安全性。2013年10月至2013年12月期间，14例肺部疾病患者在我院接受了解剖性肺段切除术（10例VATS，4例常规开胸术）。将肺动脉、静脉、支气管分离后，用静脉针将亚甲蓝0.1%（20 mL）缓慢注入肺靶段支气管内，确定边界，然后解剖切除肺靶段。染色仅需3 min。靶肺段染成蓝色，可清楚识别肺表面和肺实质中的段间平面，所有手术均顺利完成。染色不影响切除标本的病理检查。从胸管中流出的液体以及患者的痰、尿和粪便不是蓝色的。无围手术期死亡及严重并发症。据我们所知，这项研究是第一个报告了一个安全可行的亚甲基蓝染色方法，用于确定肺段边界，不需要任何特殊设备。更重要的是，这种方法可以清楚地检测胸膜表面和肺实质内的肺段间平面，使胸外科医生能够准确地进行解剖肺段切除术。(C)2015年美国胸外科医师协会
Background. Pulmonary segmentectomy is being increasingly used to resect small lung nodules; however, identifying the intersegmental plane is difficult. We describe a new methylene blue staining technique that we developed to identify the intersegmental planes in anatomic segmentectomy using video-assisted thoracic surgery (VATS) or thoracotomy and to evaluate its feasibility and safety.Methods. Between October 2013 and December 2013, 14 consecutive patients with lung disease underwent anatomic segmentectomy at our institution (10 VATS, 4 conventional thoracotomy). Methylene blue 0.1% (20 mL) was slowly injected into the bronchus of the target pulmonary segments using an intravenous needle after division of the artery, vein, and bronchus of the target segments, and the boundaries were detected, followed by anatomic segmentectomy.Results. The staining took only 3 min. The target pulmonary segments stained blue, allowing for the clear identification of the intersegmental plane on both the surface and in the lung parenchyma, and all operations were successfully completed. Staining did not affect pathologic examination of the resected specimens. The fluid that drained from the chest tube and the patients' sputum, urine, and feces were not blue. There were no perioperative deaths or major complications.Conclusions. To our knowledge, this study is the first to report a safe and feasible methylene blue staining method for identifying the lung segment borders that does not require any special equipment. More importantly, this method can clearly detect the intersegmental planes on the pleural surface and within the lung parenchyma, enabling thoracic surgeons to accurately perform anatomic segmentectomy. (C) 2015 by The Society of Thoracic Surgeons