[收稿日期]2020-03-04摇[修回日期]2020-08-24[基金项目]蚌埠医学院转化医学重点专项(BYTM2019016,BYTM2019031);安徽省教育厅自然科学研究重点项目(KJ2019A0340);蚌埠医学院科技发展基金项目(BYKF1864);蚌埠医学院第一附属医院高新技术项目(2019117)[作者单位]蚌埠医学院第一附属医院胸外科,安徽蚌埠233004[作者简介]李小军(1969-),男,副主任医师.[文章编号]1000鄄2200(2020)10鄄1363鄄04·临床医学·三维重建技术在胸腔镜肺切除手术中的临床应用李小军,张摇雷,唐摇震,朱摇潇,贡会源,王摇彪,杏福宝,高摇雄[摘要]目的:探讨三维重建支气管、肺血管和肿瘤技术进行术前手术规划及术中实时导航对胸腔镜肺切除手术的临床应用价值。方法:回顾性分析非小细胞肺癌行胸腔镜肺叶根治性切除和肺结节行肺段切除术各25例病人的临床资料。所有病人术前均行胸部薄层CT扫描,应用DeepInsight软件对支气管、肺动脉、肺静脉进行重建,同时对肺部结节、肿瘤或者肿大淋巴结进行重建;通过术前重建三维图像进行精准的术前规划,特别是肺支气管及血管的变异情况,肿瘤、肿大淋巴结与肺血管的关系,肺结节在肺段中的精准定位等。对照术前三维重建,术中实时导航进行精准手术;记录术中有无中转开胸、手术时间、术中出血及术后住院时间、引流管拔除时间及总引流量,围术期并发症发生情况。结果:全部病人清晰重建支气管及肺血管解剖结构及变异情况,对中央型肿瘤及肿大淋巴结与血管的关系重建满意,明确定位肺结节在肺段中的位置及精确的进行术前规划。全部病人进行术中实时导航,按照术前规划实施精准手术,手术顺利完成,无中转开胸及术中意外出血情况,手术时间(147.60依37.77)min,术中出血量(33.82依22.17)mL,术后住院时间(7.02依1.78)d,引流管拔除时间(4.68依1.60)d,术后总引流量(221.00依135.03)mL;围术期无严重并发症及死亡病例。结论:应用胸部薄层CT数据进行术前三维重建及术中实时导航技术,能够精准、高效、安全方便的实施胸腔镜肺叶和肺段切除手术。[关键词]胸腔镜;三维重建技术;肺叶切除术;肺段切除术[中图法分类号]R561摇摇摇[文献标志码]A摇摇摇DOI:10.13898/ki.issn.1000鄄2200.2020.10.013Applicationvalueofthree鄄dimensionalreconstructioninminimallyinvasivepulmonarysurgeryLIXiao鄄jun,ZHANGLei,TANGZhen,ZHUXiao,GONGHui鄄yuan,WANGBiao,XINGFu鄄bao,GAOXiong(DepartmentofCardiothoracicSurgery,TheFirstAffiliatedHospitalofBengbuMedicalCollege,BengbuAnhui233004,China)[Abstract]Objective:Toexploretheclinicalvalueofthepreoperativeplanningandintraoperativereal鄄timenavigationusingthethree鄄dimensional鄄reconstructionofbronchi,pulmonaryvesselsandtumorsinthoracoscopicpneumonectomy.Methods:Theclinicaldataof25non鄄smallcelllungcancerpatientstreatedwiththoracoscopicradicallobectomyand25casestreatedwithsegmentalresectionofpulmonarynoduleswereretrospectivelyanalyzed.Allpatientsweredetectedusingchestthin鄄sliceCTscanbeforeoperation,andthebronchus,pulmonaryarteryandpulmonaryveinwerereconstructedwithDeepInsightsoftware,andthepulmonarynodules,tumorsorenlargedlymphnodeswerealsoreconstructed.Theaccuratepreoperativeplanningwascarriedoutthroughthepreoperativethree鄄dimensional鄄reconstruction,especiallythevariationofpulmonarybronchusandbloodvessels.Theaccurateoperationwereimplementedusingthereal鄄timenavigationofthree鄄dimensional鄄reconstructionoftumors,enlargedlymphnodesandpulmonaryvessels.Theintraoperativeconversiontothoracotomy,operationtime,intraoperativebleedingandpostoperativehospitalstay,drainagetuberemovaltime,totaldrainagevolumeandperioperativecomplicationswererecorded.Results:Theanatomicalstructure,variationofbronchusandpulmonaryvesselswereclearlyreconstructedinallpatients,andtherelationshipbetweenthecentraltumor,enlargedlymphnodesandvesselsweresatisfactory.Thelocatoryofpulmonarynodulesinthepulmonarysegmentswasclearlyidentified,andthepreoperativeplanningwasaccuratelycarriedout.Theintraoperativereal鄄timenavigationwascarriedoutinallpatients,andtheprecisesurgerywascarriedoutaccordingtothepreoperativeplan.Theoperationwassuccessfullycompleted,andnoconversiontothoracotomyorintraoperativeaccidentalbleedingwerefound.Theoperativetimewas(147.60依37.77)min,theintraoperativebloodlosswas(33.82依22.17)mL,thepostoperativehospitalstaywas(7.02依1.78)d,thedrainagetuberemovaltimewas(4.68依1.60)d,andthepostoperativetotaldrainagevolumewas(221.00依135.03)mL.Therewerenotseriouscomplicationsanddeathinperioperativeperiod.Conclusions:摇摇摇Theapplicationofchestthin鄄sliceCTdatainpreoperativethree鄄dimensional鄄reconstructionandintraoperativenavigationcanaccurately,effectivelyandsafelyguidethethoracoscopiclobectomyandpulmonarysegmentectomy.[Keywords]thoracoscope;three鄄dimensionalreconstruction;摇摇摇摇摇摇pulmonarylobectomy;segmentectomy摇摇近年来,肺癌已成为全球发病率及死亡率最高3631蚌埠医学院学报2020年10月第45卷第10期
