摘要目的 探讨术前使用三维计算机血管扫描成像(3D-CTA)技术重建肺血管、支气管在胸腔镜复杂肺段切除术中的作用.方法 回顾性分析2012年9月至2014年8月对29例拟行复杂肺段切除的患者术前行3D-CTA重建肺血管、支气管,根据病灶大小、部位、病理确定肺段切除方式,预定切除血管、支气管,行模拟肺段切除,术中按照重建图像精准切断靶段血管、支气管,保留段间静脉,根据膨胀萎陷交界分离段间平面.结果 术前根据3D-CTA重建图像协助判断8例(27.5％)定位困难的结节的肺段归属,发现2例(6.9％)肺段动脉变异、1例(3.4％)靶段支气管变异.根据术前模拟肺段切除标注的血管,术中准确辨认靶段动脉27例(93.1％)、靶段静脉25例(86.2％)、靶段支气管29例(100％).共施行右上肺分段切除9例,左上肺固有段分段切除13例,双侧基底段分段切除7例,其中亚肺段切除6例,所有肺段切缘宽度≥2 cm.平均病灶直径(1.35±0.80) cm,平均手术时间(190.53±50.83) min,平均术中出血(26.90±32.24) ml.中转3例,无转开放病例,无严重并发症及死亡.结论 3D-CTA重建肺血管、支气管图像有助于进行精准的解剖性肺段切除,使胸腔镜复杂肺段切除安全、便利.

abstractsObjective Identification of anatomic structures are essential for totally thoracoscopic anatomic pulmonary segmentectomies, however sometimes the procedure are difficulty.This study was to assess whether three-dimensional computed tomography angiography(3D-CTA) could contribute to the preoperative arrangement of thoracoscopic complex segmentectomy.Methods Between September 2012 and August 2014, 29 patients were performed thoracoscopic complex segmentectomies under the guidance of preoperative 3D-CTA.The segmentectomies pattern were based on the nodules' diameter, location,and pathology.The targeted vessels and bronchus were marked in preoperative simulated segmentectomies.Results Of the 29 cases, 9 right upper lobe segmentectomies, 13 left upper segmentectomies, and 7 bibasilar segmentectomies were achieved, among which 6 subsegmentectomies were also inclued.The mean lesion diameter, operative time and intraoperative blood loss were(1.35 ± 0.80) cm, (190.53 ± 50.83) min, and (26.90 ± 32.24) ml respectively.Under the guidance of preoperative 3D-CTA , 8(27.5％) nodules were detected accurately, moreover 2(6.9％) aberrant arteries and 1 (3.4％) aberrant bronchus were observed.According to the marked vessels and bronchus preoperatively, 27 (93.1％) arteries, 25 (86.2％)veins,and 29(100％) bronchus were identified and dissected in the operation.Three cases converted to unplanned segmentectomies.No serious complications or death occurred.Conclusion 3D-CTA is an effective tool to enhance security and efficiency in thoracoscopic complex anatomical segmentectomy.