Zhu Xin-Yu, Yao Fei-Rong, Xu Chun, Ding Cheng, Chen Jun, Wang Wen-Yi, Pan Liu-Ying, Zhao Jun, Li Chang
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.
Ann Transl Med. 2021 Mar;9(6):480. doi: 10.21037/atm-21-474.
Personalized three-dimensional (3D) reconstruction can help surgeons to overcome technical challenges and variations of pulmonary anatomic structures in the performance of uniportal video-assisted thoracoscopic surgery (UVATS), thus improving the safety and efficacy of the procedure. This study aims to evaluate the utility of preoperative 3D-CT bronchography and angiography (3D-CTBA) with Exoview software in the assessment of anatomical variations of pulmonary vessels, and to analyze short-term surgical outcomes in patients undergoing UVATS lobectomy.
We retrospectively analyzed the data of 198 consecutive patients who underwent curative UVATS lobectomy between November 2019 and September 2020. The patients were divided into an "Exoview" group (n=53) and a "non-Exoview" group (n=145). We performed 1:1 propensity score matching and compared intraoperative and postoperative outcomes between the two groups. A subgroup analysis of 74 patients who underwent single-direction uniportal lobectomy was also conducted. Aberrant pulmonary vessel patterns related to the surgery were also examined.
The operative time in the Exoview group was significantly shorter than that in the non-Exoview group, both before (145.7±33.9 159.5±41.6 minutes, P=0.032) and after (145.7±33.9 164.2±41.8 minutes, P=0.014) propensity score matching. The number of mediastinal lymph nodes dissected was higher in the Exoview group than in the non-Exoview group (8.19±6.89 5.78±3.3, P=0.024) after propensity score matching. Intraoperative blood loss showed a statistical difference between the Exoview and non-Exoview groups (60.4±45.4 100.8±83.9, P=0.009). Four types of arterial variations and 2 types of venous variations related to the surgery were observed among 8 patients (15%), which have rarely been reported before.
Personalized preoperative 3D-CT bronchography and angiography helped to clearly visualize the pulmonary anatomical structures and could contribute to the safe and efficient performance of UVATS anatomical lobectomy.
个性化三维（3D）重建有助于外科医生在单孔电视辅助胸腔镜手术（UVATS）中克服技术挑战以及应对肺解剖结构的变异，从而提高手术的安全性和有效性。本研究旨在评估使用Exoview软件的术前3D-CT支气管造影和血管造影（3D-CTBA）在评估肺血管解剖变异中的作用，并分析接受UVATS肺叶切除术患者的短期手术结局。
我们回顾性分析了2019年11月至2020年9月期间连续接受根治性UVATS肺叶切除术的198例患者的数据。患者被分为“Exoview”组（n = 53）和“非Exoview”组（n = 145）。我们进行了1:1倾向评分匹配，并比较了两组的术中及术后结局。还对74例行单向单孔肺叶切除术的患者进行了亚组分析。同时检查了与手术相关的异常肺血管模式。
在倾向评分匹配前（145.7±33.9对159.5±41.6分钟，P = 0.032）和匹配后（145.7±33.9对164.2±41.8分钟，P = 0.014），Exoview组的手术时间均显著短于非Exoview组。倾向评分匹配后，Exoview组清扫的纵隔淋巴结数量高于非Exoview组（8.19±6.89对5.78±3.3，P = 0.024）。Exoview组和非Exoview组的术中失血量存在统计学差异（60.4±45.4对100.8±83.9，P = 0.009）。在8例患者（15%）中观察到4种与手术相关的动脉变异和2种静脉变异，此前鲜有报道。
个性化术前3D-CT支气管造影和血管造影有助于清晰显示肺解剖结构，并有助于安全、高效地进行UVATS解剖性肺叶切除术。
