3D-CTBA联合Hookwire定位在胸腔镜肺段切除术中的应用

doi:10.3877/cma.j.issn.1674-6899.2020.05.003

目的

探讨三维支气管血管重建(three-dimensional computed tomography bronchography and angiography, 3D-CTBA)技术联合Hookwire定位在电视胸腔镜手术(video-assisted thoracoscopic surgery，VATS)肺段切除术中的临床应用价值。

方法

回顾性分析2018年12月至2020年2月江阴市人民医院胸心外科48例行VATS肺段切除术患者的临床资料。所有患者术前均用Mimics 20.0软件行3D-CTBA重建肺部解剖结构，明确肺结节所在肺段及靶段支气管、血管走行，观察有无变异，决定术中所需切断和保留的支气管及动(静)脉，制订个性化手术方案；在CT引导下行Hookwire定位后入手术室行VATS解剖性肺段切除术。

结果

所有患者均未发现定位针移位和脱落并顺利完成手术，无中转开胸。Hookwire定位时间(19.71±3.94)min，发生气胸5例；手术时间(109.67±17.21)min，术中出血量(65.42±21.62)ml，术后胸管置管(4.13±1.26)d，术后胸腔引流量(548.33±228.78)ml，术后住院时间(6.25±1.48 ) d。围手术期无严重并发症，无死亡病例。

结论

术前3D-CTBA技术联合CT引导下Hookwire定位有助于术者进行安全、精准的解剖性肺段切除，具有良好的临床应用价值。

关键词: 三维重建, 支气管血管成像, Hookwire, 电视胸腔镜手术, 肺段切除术

Objective

To investigate the clinical value of three-dimensional computed tomography bronchography and angiography combined with Hookwire localization in thoracoscopic segmentectomy.

Methods

The clinical data of 48 patients undergoing thoracoscopic segmentectomy from Dec. 2018 to Feb. 2020 in our department were retrospectively analyzed in this study. All the patients underwent 3D-CTBA using the Mimics software to show the anatomy of pulmonary segments, in order to make clear the accurate location of the nodule and explicit the courses and variations of bronchi and blood vessels. So that the personalized operation scheme including the target bronchi and blood vessels to be amputated can be made before operation. All patients were treated with Hookwire localization needle under CT guidance and then thoracoscopic segmentectomy were performed.

Results

None of Hookwires dislodged or displaced during the transport to the operation room and the surgeries were successfully completed in 48 patients without a transfer to open procedure. The mean procedure time for the CT-guided Hookwire localization was (19.71±3.94)min, 5 patients of them had the pneumothorax. The mean operation time was (109.67±17.21)min, the mean intraoperative blood loss was (65.42±21.62)ml, mean thoracic tube drainage time was (4.13±1.26)d and postoperative thoracic drainage was (548.33±228.78)ml. The average postoperative hospitalization was (6.25±1.48) d. There were no serious complications or death during the perioperative period.

Conclusions

The application of preoperative 3D-CTBA combined with CT-guided Hookwire localization is helpful for safe and accurate anatomical thoracoscopic segmentectomy, which has productive clinical application value.

Key words: 3D reconstruction, Bronchography and angiography, Hookwire, Video-assisted thoracoscopic surgery, Segmentectomy

图1 3D-CTBA联合Hookwire定位应用示意

表1 48例胸腔镜肺段切除术患者切除的肺段部位(例)

所在肺段	右肺	左肺
S1	4	1
S2	5	0
S3	8	0
S1＋2	0	5
S1＋2＋3	0	7
S4＋5	0	2
S6	5	7
S7＋8	1	1
S8	1	1
S9	1	0
S10	2	1
S9＋10	1	0

表1 48例胸腔镜肺段切除术患者切除的肺段部位(例)

所在肺段	右肺	左肺
S1	4	1
S2	5	0
S3	8	0
S1＋2	0	5
S1＋2＋3	0	7
S4＋5	0	2
S6	5	7
S7＋8	1	1
S8	1	1
S9	1	0
S10	2	1
S9＋10	1	0

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Application of three-dimensional computed tomography bronchography and angiography combined with Hookwire localization in thoracoscopic segmentectomy

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Application of three-dimensional computed tomography bronchography and angiography combined with Hookwire localization in thoracoscopic segmentectomy