Watanabe Shun-ichi, Arai Kazunori, Watanabe Toshio, Koda Wataru, Urayama Hiroshi
Department of Thoracic and Vascular Surgery, Kurobe City Hospital, Kurobe, Japan.
Ann Thorac Surg. 2003 Feb;75(2):388-92; discussion 392. doi: 10.1016/s0003-4975(02)04375-8.
Identification and appropriate treatment of the pulmonary artery (PA) is a key to successful anatomic resection of the lung. Preoperative identification of branching pattern of the PA seems to make pulmonary resection easier and safer especially when there is severe adhesion or incomplete fissure between the lobes. With the development of the multidetector row spiral computed tomography (MDCT), three-dimensional (3D) CT angiography can be obtained easily and can provide very useful information about various organs. We studied the usefulness of 3D-CT pulmonary angiography (3D-CTPA) in evaluating the PA branching pattern before anatomic pulmonary resection.
Fourteen patients with primary lung cancer undergoing anatomic pulmonary resections were the subjects of this study. The 3D-CTPA images were obtained using MDCT. The obtained images of the PA branching pattern were compared with intraoperative findings in each case at the time of thoracotomy.
MDCT scanning required approximately 15 seconds per patient during a single respiratory pause and the 3D images were processed within 10 minutes after scannning. According to intraoperative findings, 98% (84 of 86) of PA branches were revealed to be successfully identified on preoperative 3D-CTPA. Two missed branches on 3D-CTPA were small vessels, which were less than 1.5 mm in actual diameter. Pulmonary vessels were clearly identified even when contrast medium was not administered intravenously.
Obtaining 3D-CTPA using MDCT is noninvasive yet it provides precise preoperative information regarding pulmonary vessels. This technique is a far less invasive and an easier investigation than conventional pulmonary angiography. The 3D-CTPA navigation may have the potential to increase the safety of surgical procedure and to reduce surgical morbidity in anatomic lung resection.
肺动脉（PA）的识别与恰当处理是肺解剖性切除成功的关键。术前识别PA的分支模式似乎能使肺切除更简便、安全，尤其是当叶间存在严重粘连或裂隙不完整时。随着多排螺旋计算机断层扫描（MDCT）的发展，三维（3D）CT血管造影可轻松获得，并能提供有关各种器官的非常有用的信息。我们研究了3D-CT肺血管造影（3D-CTPA）在评估解剖性肺切除术前PA分支模式方面的实用性。
本研究的对象为14例接受解剖性肺切除的原发性肺癌患者。使用MDCT获取3D-CTPA图像。将获得的PA分支模式图像与开胸手术时各病例的术中发现进行比较。
MDCT扫描在单次呼吸暂停期间每位患者约需15秒，扫描后10分钟内即可处理3D图像。根据术中发现，术前3D-CTPA成功识别出98%（86支中的84支）的PA分支。3D-CTPA上遗漏的2支分支为小血管，实际直径小于1.5毫米。即使未静脉注射造影剂，肺血管也能清晰识别。
使用MDCT获取3D-CTPA是无创的，但它能提供有关肺血管的精确术前信息。与传统肺血管造影相比，该技术侵入性小得多且操作更简便。3D-CTPA导航可能有潜力提高手术安全性并降低解剖性肺切除的手术发病率。
