Xu Yuyang, Gan Fanyi, Xia Chunchao, Wang Zihuai, Zhao Kejia, Li Chuan, Mei Jiandong, Liu Chengwu, Liao Hu, Pu Qiang, Liu Lunxu
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
West China Precision Medicine Industrial Technology Institute, Chengdu 610041, China.
Transl Lung Cancer Res. 2019 Dec;8(6):1061-1072. doi: 10.21037/tlcr.2019.12.21.
The lack of anatomic landmarks between segments on the lung surface makes the identification of intersegmental planes one of the greatest challenges in anatomic segmentectomy. Therefore, with the aim to determine the landmarks of intersegmental planes on the lung surface, we used three-dimensional (3D) reconstruction and morphological measurement techniques to reconstruct stereoscopic models of all pulmonary segments, and measured the length of each segment on the lung surface along the lobe's anatomic landmark lines.
We downloaded the primary computed tomography (CT) scan data of 619 patients and imported them into a 3D reconstruction system, which could automatically reconstruct the 3D model of the trachea-bronchi system. We manually reconstructed the intersegmental veins to ensure the accuracy of segmental boundary. The 3D models of pulmonary segments could be reconstructed based on the bronchial tree and the pathways of the intersegmental veins. We then measured the length of each segment on the lung surface along the lobe's anatomic landmark lines and calculated the proportions between these lengths.
Complete 3D segmental models were successfully reconstructed in 500 patients (241 male and 259 female), and the lengths of every segment on the lung surface along the lobe's anatomic landmark lines were measured. Our data revealed that the length of each segment on lung surface varied among individuals. However, the proportions between these lengths stayed constant, even when stratified by gender, age, height, and weight.
We discovered that the proportion between the lengths of adjacent segments on the lung surface stayed constant. The constant proportion reflected and uncovered the lung surface intersegmental landmarks, which could help direct surgeons to identify intersegmental planes during anatomic segmentectomy in an easy and safe way without additional cost.
肺表面各肺段之间缺乏解剖标志，这使得识别肺段间平面成为解剖性肺段切除术中最大的挑战之一。因此，为了确定肺表面肺段间平面的标志，我们使用三维（3D）重建和形态测量技术重建了所有肺段的立体模型，并沿着叶的解剖标志线测量了肺表面各肺段的长度。
我们下载了619例患者的胸部计算机断层扫描（CT）原始数据，并将其导入3D重建系统，该系统可自动重建气管 - 支气管系统的3D模型。我们手动重建肺段间静脉以确保肺段边界的准确性。基于支气管树和肺段间静脉的走行可以重建肺段的3D模型。然后，我们沿着叶的解剖标志线测量肺表面各肺段的长度，并计算这些长度之间的比例。
500例患者（男性241例，女性259例）成功重建了完整的3D肺段模型，并测量了肺表面各肺段沿着叶的解剖标志线的长度。我们的数据显示，肺表面各肺段的长度因人而异。然而，即使按性别、年龄、身高和体重分层，这些长度之间的比例保持不变。
我们发现肺表面相邻肺段长度之间的比例保持恒定。该恒定比例反映并揭示了肺表面的肺段间标志，这有助于指导外科医生在解剖性肺段切除术中以简单、安全的方式识别肺段间平面，且无需额外成本。
