Cui Zihan, Ding Cheng, Li Chang, Song Xinyu, Chen Jun, Chen Tengfei, Xu Chun, Zhao Jun
Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, China.
Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
J Thorac Dis. 2020 Aug;12(8):4196-4204. doi: 10.21037/jtd-20-1014.
"Exoview" is a three-dimensional (3D) image reconstruction software developed by our medical team independently. The aim of this retrospective study was to compare the use of 3D image reconstruction, and thin-section multi-detector computed tomography (MDCT) in the preoperative evaluation of the segmental artery (SA).
From May 2018 to May 2019, 52 patients received anatomical segmentectomy in our department. All patients received computed tomography pulmonary angiography (CTPA) by use of a 64-slice MDCT before operation. Then the 2D CT data were converted into 3D format by use of Exoview. We compared the intraoperative findings of the SA branches with 3D images and thin-section MDCT.
The study cohort of 52 patients included 31 women and 21 men and the operative factors include operation time (148.75±53.56 min), blood loss (57.31±79.68 mL), postoperative hospitalization days (6.42±3.48 days), lymph node sampling (3.00±1.50 stations) and postoperative complications (5 patients, 10%). The adenocarcinoma with microinvasion was the predominant type (25 cases, 48%). There were 7 patients accepted for video-assisted thoracoscopic surgery (VATS) lobectomy with radical lymph nodes dissection because invasive adenocarcinoma was confirmed by intraoperative frozen-section analysis. One other patient was confirmed for conversion from VATS segmentectomy to an open operation because of bleeding of the bronchial artery. According to intraoperative findings, 95.7% (132 of 138) and 100% (138 of 138) of these SA branches were precisely identified on preoperative 3D image reconstruction and thin-section MDCT images. The 6 missed branches were less than 1.4 mm in actual diameter.
Both 3D image reconstruction and thin-section MDCT provided precise preoperative information about SA. The 3D image reconstruction software "Exoview" could visualize SA for surgeons. However, the thin-section MDCT provided a better evaluation of small SA branches.
“Exoview”是由我们的医学团队自主研发的三维（3D）图像重建软件。这项回顾性研究的目的是比较3D图像重建和薄层多排螺旋计算机断层扫描（MDCT）在段动脉（SA）术前评估中的应用。
2018年5月至2019年5月，52例患者在我科接受解剖性肺段切除术。所有患者术前均使用64排MDCT进行计算机断层扫描肺动脉造影（CTPA）。然后使用Exoview将二维CT数据转换为三维格式。我们将SA分支的术中发现与3D图像和薄层MDCT进行了比较。
52例患者的研究队列包括31名女性和21名男性，手术相关因素包括手术时间（148.75±53.56分钟）、出血量（57.31±79.68毫升）、术后住院天数（6.42±3.48天）、淋巴结采样（3.00±1.50站）和术后并发症（5例，10%）。微浸润腺癌是主要类型（25例，48%）。7例患者因术中冰冻切片分析确诊为浸润性腺癌，接受了电视辅助胸腔镜手术（VATS）肺叶切除加根治性淋巴结清扫术。另1例患者因支气管动脉出血，由VATS肺段切除术转为开放手术。根据术中发现，这些SA分支在术前3D图像重建和薄层MDCT图像上的精确识别率分别为95.7%（138个中的132个）和100%（138个中的138个）。6个漏诊分支的实际直径小于1.4毫米。
3D图像重建和薄层MDCT均能提供关于SA的精确术前信息。3D图像重建软件“Exoview”可为外科医生可视化SA。然而，薄层MDCT对小SA分支的评估更好。
