Sato Masaaki
Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan.
Kyobu Geka. 2018 Sep;71(10):862-867.
There are several different approaches to identify inter-segmental planes in segmentectomy. Inflation-deflation lines can be made by inflating the lung after clumping or resecting the target bronchus, or inflate the target bronchus by jet ventilation, direct tubing, or applying a slip-knot. Indocyanine green can be injected intravenously after resecting or clumping the target pulmonary artery to identify the target segment under an infra-red thoracoscope. Indocyanine green can also be injected through a target bronchus. Virtual-assisted lung mapping (VAL-MAP) is a bronchoscopic multispot dye marking technique. Although VAL-MAP was developed to localize small pulmonary nodules, the multiple marks that provide geometric information on the lung enables application of VAL-MAP to segmentectomy, putting more emphasis on resection margins than accurate identification of intersegmental planes. As such, VAL-MAP is particularly useful in extended or complex segmentectomies. There are advantages and disadvantages in each method. The rapid progress of technology is likely to advance each method further. Taking these into consideration, surgeons need to choose an appropriate technique and possibly combination of these techniques to obtain optimal outcomes in segmentectomy.
在肺段切除术中，有几种不同的方法来识别肺段间平面。可通过在结扎或切除目标支气管后使肺膨胀、或通过喷射通气、直接插管或系活结使目标支气管膨胀来形成膨胀-萎陷线。在切除或结扎目标肺动脉后，可静脉注射吲哚菁绿，在红外胸腔镜下识别目标肺段。吲哚菁绿也可通过目标支气管注射。虚拟辅助肺绘图（VAL-MAP）是一种支气管镜多点染料标记技术。虽然VAL-MAP最初是为定位小的肺结节而开发的，但在肺上提供几何信息的多个标记使VAL-MAP能够应用于肺段切除术，相比于准确识别肺段间平面，更强调切除边缘。因此，VAL-MAP在扩大或复杂的肺段切除术中特别有用。每种方法都有优缺点。技术的快速发展可能会进一步推动每种方法的进步。考虑到这些，外科医生需要选择合适的技术，可能还需要将这些技术结合起来，以在肺段切除术中获得最佳结果。
