Limmer S, Dicken V, Kujath P, Krass S, Stöcker C, Wendt N, Unger L, Hoffmann M, Vogt F, Kleemann M, Bruch H-P, Peitgen H-O
Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland.
Chirurg. 2010 Sep;81(9):833-40. doi: 10.1007/s00104-009-1828-3.
CT scanning of the lungs is the standard procedure for preoperative evaluation of central lung tumors. The extent of the tumor and infiltration of central lung structures or lung segments are decisive parameters to clarify whether surgery is possible and the extent of resection. With computer-assisted methods for the segmentation of anatomical structures based on CT data (Fraunhofer MeVis, Bremen) an enhanced, three-dimensional selective visualization is now possible.
From August 2007 through June 2009, 22 patients with central lung tumors were treated at the department of thoracic surgery, University of Schleswig-Holstein, campus Lübeck. There were 15 males and 7 females with a mean age of 60.2 years (range 41-74 years), 18 patients had a long history of smoking, while 4 patients had never smoked. Of the patients 20 had a primary lung carcinoma, 1 patient had local recurrent lung cancer after lobectomy and 1 patient had a central lung metastasis from a non-pulmonary primary carcinoma. A multi-slice detector computer tomogram (MSDCT) scan was performed in all cases. All data were three-dimensionally reconstructed and visualized using special computer-aided software (Fraunhofer MeVis, Bremen). Pulmonary lung function tests, computed postoperative lung volume, bronchoscopic findings, general condition of the patients and the three-dimensionally reconstructed CT data were used for an individual risk analysis and surgical planning.
According to the risk analysis 14 out of the 22 patients were surgically treated, 7 patients were staged as functionally inoperable and 1 as technically inoperable. A pneumonectomy was performed in 5 cases, a lobectomy/bilobectomy in 4 cases, an extended lobectomy in 3 cases and 1 case each of a wedge resection and a sleeve resection. Of the 14 patients 2 were classified as stage Ia/b, 7 patients as stage IIa/b and 5 patients as stage IIIa. The median length of time spent in hospital was 8.5±33 days and the mortality rate was 0%. The three-dimensional visualization of the tumor and its anatomical relationship to central pulmonary vessels and the airway system was feasible in all cases. The three-dimensional reconstruction was confirmed in all cases by surgical exploration.
Three-dimensional reconstruction of CT scan data is a new and promising method for preoperative presentation and risk analysis of central lung tumors. The three-dimensional visualization with anatomical reformatting and color-coded segmentation enables the surgeon to make a more precise strategic approach for central lung tumors.
肺部CT扫描是中央型肺肿瘤术前评估的标准程序。肿瘤范围以及中央肺结构或肺段的浸润情况是明确是否可行手术及切除范围的决定性参数。借助基于CT数据的计算机辅助解剖结构分割方法（弗劳恩霍夫·梅维斯公司，不来梅），现在可以实现增强的三维选择性可视化。
2007年8月至2009年6月，石勒苏益格－荷尔斯泰因大学吕贝克校区胸外科收治了22例中央型肺肿瘤患者。其中男性15例，女性7例，平均年龄60.2岁（范围41 - 74岁），18例患者有长期吸烟史，4例患者从不吸烟。20例患者为原发性肺癌，1例患者为肺叶切除术后局部复发性肺癌，1例患者为非肺原发性癌的中央型肺转移。所有病例均进行了多层螺旋CT扫描。所有数据均使用特殊的计算机辅助软件（弗劳恩霍夫·梅维斯公司，不来梅）进行三维重建和可视化。肺功能测试、计算术后肺容积、支气管镜检查结果、患者的一般状况以及三维重建的CT数据用于个体风险分析和手术规划。
根据风险分析，22例患者中有14例接受了手术治疗，7例患者被判定为功能上无法手术，1例为技术上无法手术。5例行全肺切除术，4例行肺叶切除/双肺叶切除术，3例行扩大肺叶切除术，1例行楔形切除术和1例行袖状切除术。14例患者中，2例为Ia/b期，7例为IIa/b期，5例为IIIa期。中位住院时间为8.5±33天，死亡率为0%。在所有病例中，肿瘤及其与中央肺血管和气道系统的解剖关系的三维可视化都是可行的。所有病例的三维重建均通过手术探查得到证实。
CT扫描数据的三维重建是一种用于中央型肺肿瘤术前呈现和风险分析的新的且有前景的方法。具有解剖结构重新格式化和彩色编码分割的三维可视化使外科医生能够对中央型肺肿瘤采取更精确的策略性方法。
