评价3D-CTBA指导下胸腔镜劈裂式肺段切除术治疗深部肺结节的可行性及围术期安全性。

回顾性分析2020年1月至2024年12月单中心连续筛查行胸腔镜劈裂式肺段切除术患者的临床资料。深部肺结节定义为深度比>1/3。术前采用薄层CT及三维重建评估病灶与肺段、亚段支气管血管的空间关系，并以2 cm虚拟切缘球规划个体化切除范围；术中通过劈裂肺实质建立解剖通道，完成单一肺段或亚段切除，或肺段与亚段联合切除。观察手术计划完成情况、切缘距离及围术期结局。

共筛查30例，排除外周肺结节6例，最终纳入24例。病灶最大径为(0.99±0.27)cm，深度比为(0.40±0.06)。共采用13种个体化切除方式，24例均按术前计划完成手术，无扩大切除或转行肺叶切除。切缘距离为(2.14±0.37)cm，手术时间为(143.0±46.2)min，术中出血量为(44.2±17.5)ml，术后住院时间为(3.33±0.84) d。持续漏气超过5 d者2例(8.3%)，无再手术、再入院及30 d死亡。

在严格病例选择和三维重建规划基础上，3D-CTBA指导下胸腔镜劈裂式肺段切除术治疗深部肺结节安全可行，可获得充分切缘。

To evaluate the feasibility and perioperative safety of three-dimensional computed tomography bronchography and angiography (3D-CTBA)-guided thoracoscopic split segmentectomy for deep pulmonary nodules.

Clinical data of consecutive patients screened for thoracoscopic split segmentectomy at a single center between Jan. 2020 and Dec. 2024 were retrospectively reviewed. A deep pulmonary nodule was defined as a nodule with a depth ratio >1/3. Preoperative thin-section computed tomography and three-dimensional reconstruction were used to assess the spatial relationships between the lesion and the segmental or subsegmental bronchi and vessels. A virtual 2-cm margin sphere was used to plan the individualized extent of resection. Intraoperatively, the lung parenchyma was split to establish an anatomical access route, followed by single segmentectomy or subsegmentectomy, or combined segmental and subsegmental resection. Outcomes included completion of the planned procedure, surgical margin distance, and perioperative outcomes.

Thirty patients were screened, of whom 6 with peripheral pulmonary nodules were excluded, leaving 24 patients for analysis. The mean lesion diameter was 0.99±0.27 cm, and the mean depth ratio was 0.40±0.06. Thirteen individualized resection combinations were performed. All 24 procedures were completed as planned, without extended resection or conversion to lobectomy. The mean surgical margin distance was 2.14±0.37 cm, operative time was 143.0±46.2 min, intraoperative blood loss was 44.2±17.5 mL, and postoperative hospital stay was 3.33±0.84 days. Prolonged air leak lasting >5 days occurred in 2 patients (8.3%). No reoperation, readmission, or 30-day mortality was observed.

With strict patient selection and three-dimensional reconstruction-based planning, split segmentectomy is safe and feasible for deep pulmonary nodules and can achieve adequate surgical margins.