Abstract
Objective. To investigate the clinical value of 3D computed tomography bronchoangiography (3D CTBA) in thoracoscopic anatomical lung segment resection or combined lung segment resection. Methods. The clinical data of 25 patients with non-small-cell lung cancer who underwent thoracoscopic radical lobectomy and pulmonary segmentectomy with pulmonary nodules were retrospectively analyzed. All patients underwent preoperative thin-slice CT scan, and the bronchus, pulmonary artery, and pulmonary vein were reconstructed by DeepInsight software. Meanwhile, pulmonary nodules, tumors, or enlarged lymph nodes were reconstructed. Accurate preoperative planning was carried out through preoperative reconstruction of three-dimensional images, especially the variation of pulmonary bronchus and blood vessels, the relationship between tumors and enlarged lymph nodes and pulmonary blood vessels, and the precise positioning of pulmonary nodules in pulmonary segments. Compared with preoperative three-dimensional reconstruction, intraoperative real-time navigation can achieve accurate operation. The intraoperative conversion to thoracotomy, operative time, intraoperative bleeding and postoperative hospitalization time, drainage tube removal time and total drainage volume, and the incidence of perioperative complications were recorded. Results. The anatomical structure and variation of bronchus and pulmonary vessels were clearly reconstructed in all patients, and the reconstruction of the relationship between central tumor and enlarged lymph nodes and blood vessels was satisfactory. The location of pulmonary nodules in pulmonary segments was clearly defined, and preoperative planning was performed accurately. All patients underwent real-time intraoperative navigation, and precise surgery was performed according to the preoperative planning. The operation was successfully completed without any transfer to thoracotomy or intraoperative accidental bleeding. The operative time was (147.60 ± 37.77) min, the intraoperative blood loss was (33.82 ± 22.17) mL, the postoperative hospital stay was (7.02 ± 1.78) d, drainage tube removal time was (4.68 ± 1.60) d, and postoperative total drainage volume was (221.00 ± 135.03) mL; there were no severe complications and no death during perioperative period. Conclusion. The application of three-dimensional reconstruction technique for preoperative evaluation and subsequent thoracoscopic pulmonary segmental resection can achieve accurate, safe, and effective pulmonary segmental resection, reduce the difficulty of thoracoscopic pulmonary segmental resection, reduce the risk of surgery, and improve the surgical effect.
Highlights
An increasing number of asymptomatic ground glass nodules (GGNs) with diameter ≤2 cm have been found in physical examination
Thoracoscopic lobectomy has been widely used as a standard operation in clinical practice, but for patients with small pulmonary nodules, lobectomy may cause significant lung function injury and affect postoperative quality of life, especially for patients with poor preoperative lung function or elderly patients
Accurate pulmonary segmental resection can completely remove small pulmonary nodules and ensure negative surgical margin and retain more effective lung function, which is conducive to rapid postoperative recovery of patients. erefore, it is important to carry out precise pulmonary segmentectomy under the principle of ensuring oncology. ree-dimensional reconstruction can clearly locate small pulmonary nodules from stereoscopic vision, predict the resection range, and find the abnormal blood vessels and bronchus, making the operation more accurate and safe. is study retrospectively analyzed the significance of preoperative three-dimensional reconstruction in thoracoscopic pulmonary segmental resection or combined pulmonary segmental resection, in order to provide data for clinical practice
Summary
To investigate the clinical value of 3D computed tomography bronchoangiography (3D CTBA) in thoracoscopic anatomical lung segment resection or combined lung segment resection. Pulmonary nodules, tumors, or enlarged lymph nodes were reconstructed. Accurate preoperative planning was carried out through preoperative reconstruction of three-dimensional images, especially the variation of pulmonary bronchus and blood vessels, the relationship between tumors and enlarged lymph nodes and pulmonary blood vessels, and the precise positioning of pulmonary nodules in pulmonary segments. Compared with preoperative three-dimensional reconstruction, intraoperative real-time navigation can achieve accurate operation. E anatomical structure and variation of bronchus and pulmonary vessels were clearly reconstructed in all patients, and the reconstruction of the relationship between central tumor and enlarged lymph nodes and blood vessels was satisfactory. All patients underwent real-time intraoperative navigation, and precise surgery was performed according to the preoperative planning. Conclusion. e application of three-dimensional reconstruction technique for preoperative evaluation and subsequent thoracoscopic pulmonary segmental resection can achieve accurate, safe, and effective pulmonary segmental resection, reduce the difficulty of thoracoscopic pulmonary segmental resection, reduce the risk of surgery, and improve the surgical effect
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