Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan.
Department of Thoracic Surgery, Kimitsu Central Hospital, Chiba, Japan.
Semin Thorac Cardiovasc Surg. 2019 Autumn;31(3):595-602. doi: 10.1053/j.semtcvs.2019.01.004. Epub 2019 Jan 5.
We developed a novel approach combined with 3D image analyzer and infrared thoracoscopy for pulmonary sublobar resection. The purpose of this study was to investigate the feasibility of this procedure. From October 2014 to April 2018, 65 cases were enrolled, and 58 cases were evaluated. For each case, several virtual sublobar resections were created by 3D image analyzer preoperatively. The surgical margin was measured in each simulated sublobar resection and the most appropriate procedure was selected. Surgical resection with matching virtual sublobar resection was performed using infrared thoracoscopy with transbronchial indocyanine green (ICG) instillation. We evaluated the border clarity of ICG fluorescence to investigate success of ICG injection and compared pre- and postoperative CTs to determine whether the correct area could be removed according to the simulation. We also compared short-term surgical outcomes between the ICG cases and historical segmentectomy cases by propensity score matching. The success rate of transbronchial ICG injections was 89.2% (58/65). These 58 patients were eligible for evaluation of our procedure. Sublobar resection included subsegmental resection (5), simple segmentectomy (15), complex segmentectomy (16), and extended segmentectomy (22). The shortest distances to the surgical margin by simulation and by actual measurement were 21.5 ± 11.2 mm and 23.5 ± 8.3, respectively (P = 0.190). Fifty-four of 58 cases underwent sublobar resection matched with the simulation (93.1% concordance rate). Operative results and short-term outcomes were similar between the 2 groups by propensity score matching. ICG-guided sublobar resection by transbronchial ICG instillation is feasible and applicable to any type of sublobar resection.
我们开发了一种新的方法，结合 3D 图像分析器和红外胸腔镜进行肺亚肺叶切除术。本研究的目的是探讨该方法的可行性。从 2014 年 10 月至 2018 年 4 月，共纳入 65 例患者，其中 58 例进行了评估。对于每例患者，术前通过 3D 图像分析器创建几个虚拟的亚肺叶切除术。在每个模拟的亚肺叶切除术中测量手术边界，并选择最合适的手术方式。使用红外胸腔镜和经支气管吲哚菁绿（ICG）注射进行与虚拟亚肺叶切除术相匹配的手术切除。我们评估了 ICG 荧光的边界清晰度，以研究 ICG 注射的成功率，并比较术前和术后 CT 以确定是否可以根据模拟切除正确的区域。我们还通过倾向评分匹配比较了 ICG 组和历史节段切除术组的短期手术结果。经支气管 ICG 注射成功率为 89.2%（58/65）。这 58 例患者符合我们手术方法的评估标准。亚肺叶切除包括亚段切除（5 例）、单纯节段切除术（15 例）、复杂节段切除术（16 例）和扩展节段切除术（22 例）。模拟和实际测量的手术边界最短距离分别为 21.5 ± 11.2mm 和 23.5 ± 8.3mm（P=0.190）。58 例中有 54 例患者进行了与模拟匹配的亚肺叶切除术（符合率为 93.1%）。通过倾向评分匹配，两组的手术结果和短期结果相似。经支气管 ICG 注射引导的亚肺叶切除术是可行的，适用于任何类型的亚肺叶切除术。
