Xu Guobing, Du Jianting, Chen Chun, Zheng Wei, Chen Hao, Xiao Jiazhou, Wu Weixin
Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China.
Transl Cancer Res. 2021 Nov;10(11):4702-4713. doi: 10.21037/tcr-21-822.
Few reliable methods to simulate and evaluate the intersegmental plane have been reported. We introduce intersegmental plane simulation based on the bronchus-vein-artery triad in three-dimensionally reconstructed images from patients who underwent segmentectomy for early lung cancer.
We collected clinical data of consecutive patients with early-stage lung cancer who underwent three-dimensional imaging-guided single-port thoracoscopic segmentectomy at Department No. 1 of Thoracic Surgery at Fujian Medical University Fujian Union Hospital from January 2019 to July 2019. Patients were divided into two groups according to the application of intersegmental plane simulation and nodule analysis: the intersegmental plane group and the non-intersegmental plane group. General clinical characteristics, operation status, and postoperative recovery were compared between groups. The three-dimensional reconstruction results in the intersegmental plane group were analyzed and summarized.
A total of 120 patients were included (61 in the intersegmental plane group and 59 in the non-intersegmental plane group). There were no significant differences between the two groups in general characteristics (all P>0.05). All target lesions were resected in both groups. There were no significant differences between groups in operation characteristics or postoperative recovery, with the exception of the duration of chest drainage and the rate of gross margin insufficiency. There were five cases of gross margin insufficiency in the non-intersegmental plane group. With three-dimensional imaging reconstruction, a total of 131 intersegmental veins could be used to evaluate the simulated intersegmental plane in 61 patients, with an average of 2.1±0.5 veins per patient. Two patients (3.3%) had one vein that could be used to evaluate the intersegmental plane, 50 patients (82.3%) had two, seven patients (11.3%) had three, and two patients (3.3%) had four. The total number of intersegmental veins located on the simulated intersegmental plane was 124 (94.7%), with an average of 2.0±0.6 veins per patient. The accuracy of intersegmental plane simulation was 91.8% (56/61).
The bronchus-vein-artery triad in intersegmental plane simulation can assist surgeons in preoperative planning and can facilitate complete resection of early lung cancer with sufficient surgical margins.
目前报道的用于模拟和评估肺段间平面的可靠方法较少。我们介绍一种基于支气管 - 静脉 - 动脉三联征的肺段间平面模拟方法，该方法应用于接受早期肺癌肺段切除术患者的三维重建图像。
我们收集了2019年1月至2019年7月在福建医科大学附属协和医院胸外科一区接受三维成像引导下单孔胸腔镜肺段切除术的连续早期肺癌患者的临床资料。根据是否应用肺段间平面模拟和结节分析将患者分为两组：肺段间平面组和非肺段间平面组。比较两组患者的一般临床特征、手术情况及术后恢复情况。对肺段间平面组的三维重建结果进行分析总结。
共纳入120例患者（肺段间平面组61例，非肺段间平面组59例）。两组患者的一般特征比较差异无统计学意义（均P>0.05）。两组所有目标病灶均被切除。除胸腔引流时间和切缘不足率外，两组患者的手术特征及术后恢复情况比较差异无统计学意义。非肺段间平面组有5例切缘不足。通过三维成像重建，61例患者中共有131条肺段间静脉可用于评估模拟的肺段间平面，平均每位患者2.1±0.5条静脉。2例患者（3.3%）有1条静脉可用于评估肺段间平面，50例患者（82.3%）有2条，7例患者（11.3%）有3条，2例患者（3.3%）有4条。位于模拟肺段间平面上的肺段间静脉总数为124条（94.7%），平均每位患者2.0±0.6条。肺段间平面模拟的准确率为91.8%（56/61）。
肺段间平面模拟中的支气管 - 静脉 - 动脉三联征可协助外科医生进行术前规划，并有助于早期肺癌的完整切除及获得足够的手术切缘。
