Xu Guobing, Chen Chun, Zheng Wei, Zhu Yong, Chen Hao, Cai Bingqiang
Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China.
J Thorac Dis. 2019 May;11(5):2058-2066. doi: 10.21037/jtd.2019.04.83.
This study's objective was to evaluate and summarize the application of the IQQA-3D imaging interpretation and analysis system in uniportal video-assisted thoracoscopic anatomical segmentectomy.
We collected the clinical data of consecutive patients who underwent uniportal video-assisted thoracoscopic anatomical segmentectomy for single or multiple pulmonary nodules at Department No. 1 of Thoracic Surgery at Fujian Medical University, Fujian Union Hospital from July 2017 to November 2018. Patients were divided into two groups according to the use of IQQA: the IQQA group and non-IQQA group. General clinical characteristics, operation status, and postoperative recovery were compared between groups. Variations in the segmental bronchi, arteries, and veins of patients in the IQQA group were summarized.
This study included 133 cases, 96 in the IQQA group and 37 in the non-IQQA group. There were no significant differences between groups in patient sex, age, preoperative smoking, pulmonary function, maximum lesion diameter, or pathological type (all P>0.05). The proportion of segmentectomies that were moderately difficult or complex was significantly higher in the IQQA group than in the non-IQQA group (28.1% 16.2% and 29.2% 13.5%, respectively; P=0.017). Despite having a higher percentage of more complicated operations, the IQQA group did not have longer operation times or increased postoperative complications. Fifty-five cases (57.3%) in the IQQA group had segmental structure variations, with a total of 73 variations. Among patients who underwent IQQA, 27 (65.9%) in the general segmentectomy group, 13 (48.1%) in the moderate segmentectomy group, and 15 (53.6%) in the complex segmentectomy group had anatomic variations; these differences were not significant.
Preoperative 3D reconstruction is necessary before segmentectomy, especially for patients undergoing moderate or complex segmentectomy. IQQA was safe and feasible for preoperative localization of lesions, surgical planning, and intraoperative navigation in uniportal video-assisted thoracoscopic anatomical segmentectomy and can facilitate complicated segmentectomy.
本研究的目的是评估和总结IQQA - 3D成像解读与分析系统在单孔电视胸腔镜解剖性肺段切除术中的应用。
我们收集了2017年7月至2018年11月在福建医科大学附属协和医院胸外科一病区因单个或多个肺结节接受单孔电视胸腔镜解剖性肺段切除术的连续患者的临床资料。根据IQQA的使用情况将患者分为两组：IQQA组和非IQQA组。比较两组患者的一般临床特征、手术情况及术后恢复情况。总结IQQA组患者的段支气管、动脉和静脉的变异情况。
本研究共纳入133例患者，其中IQQA组96例，非IQQA组37例。两组患者在性别、年龄、术前吸烟情况、肺功能、最大病灶直径或病理类型方面均无显著差异（所有P>0.05）。IQQA组中难度为中等或复杂的肺段切除术的比例显著高于非IQQA组（分别为28.1%对16.2%和29.2%对13.5%；P = 0.017）。尽管IQQA组中复杂手术的比例较高，但该组患者的手术时间并未延长，术后并发症也未增加。IQQA组中有55例（57.3%）存在段结构变异，共有73处变异。在接受IQQA的患者中，普通肺段切除术组有27例（65.9%）、中等难度肺段切除术组有13例（48.1%）、复杂肺段切除术组有15例（53.6%）存在解剖变异；这些差异无统计学意义。
在进行肺段切除术之前，术前三维重建是必要的，尤其是对于接受中等或复杂肺段切除术的患者。IQQA在单孔电视胸腔镜解剖性肺段切除术中用于术前病灶定位、手术规划及术中导航是安全可行的，并且可以促进复杂肺段切除术的进行。
