Nagata Toshiyuki, Nakamura Yoshihiro, Kariatsumari Kota, Otsuka Tsunayuki, Aoki Masaya, Sato Masami
Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan.
Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
Asian Cardiovasc Thorac Ann. 2016 Sep;24(7):676-80. doi: 10.1177/0218492316660452. Epub 2016 Jul 22.
During pulmonary resection, we sometimes encounter "pitfall branches" of the pulmonary artery, which could cause serious vessel injury. Current computed tomography and computer-processing technology can identify the pulmonary artery along the peripheral bronchus, thereby revealing the true rates of different pulmonary artery branching patterns. Knowledge of these branching patterns allows safe and definitive surgery.
In 186 cases of left lung resection performed at our institution from January 2006 to September 2011, two general thoracic surgeons and one radiologist independently reviewed computed tomography images and examined the branches of the pulmonary artery arising from the pars mediastinalis.
Branching patterns of the lingular artery included 17 (9.2%) cases with mediastinal origin, 50 (26.9%) with interlobar and mediastinal origin, and 119 (63.9%) with interlobar origin. The 2 types of lingular artery of mediastinal origin, which were potentially overlooked during surgery, were observed in 36.1% of cases. This was a higher rate than previously reported. Moreover, a mediastinal basal pulmonary artery (A(5+8+10) abnormal branching) was seen in one case.
Potentially overlooked branches of the left pulmonary artery arising from the pars mediastinalis are much more frequent than we expected. It is crucial to understand the branching pattern of the pulmonary artery by preoperative computed tomography assessment.
在肺切除术中，我们有时会遇到肺动脉的“陷阱分支”，这可能导致严重的血管损伤。当前的计算机断层扫描和计算机处理技术可以沿着外周支气管识别肺动脉，从而揭示不同肺动脉分支模式的真实发生率。了解这些分支模式有助于进行安全且确切的手术。
在2006年1月至2011年9月于我院进行的186例左肺切除病例中，两名普通胸外科医生和一名放射科医生独立回顾计算机断层扫描图像，并检查源自纵隔部的肺动脉分支。
舌动脉的分支模式包括17例（9.2%）纵隔起源、50例（26.9%）叶间和纵隔起源以及119例（63.9%）叶间起源。在36.1%的病例中观察到2种纵隔起源的舌动脉，这在手术中可能被忽视。这一发生率高于先前报道。此外，在1例中发现了纵隔基底肺动脉（A(5+8+10)异常分支）。
源自纵隔部的左肺动脉潜在被忽视的分支比我们预期的要频繁得多。通过术前计算机断层扫描评估了解肺动脉的分支模式至关重要。
