Key labortatory of Cardio-Thoracic Surgery (Fujian Medical university), Fujian Province University, Fuzhou, China.
Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Thorac Cancer. 2022 Sep;13(17):2436-2442. doi: 10.1111/1759-7714.14554. Epub 2022 Jul 18.
In this article, we aimed to reconstruct the cervical-thoracic junction plane (CTJP) using a three-dimensional (3D) reconstruction system. Thus, the CTJP can be judged during surgery to better distinguish cervical-thoracic lymph nodes.
We included patients in Fujian Medical University Union Hospital from December 2019 to March 2020. All patients underwent a thin-slice and enhanced computed tomography scan of the chest with 3D reconstruction using the IQQA system (EDDA technology) to reconstruct the CTJP, brachiocephalic trunk, right common carotid artery, and right subclavian artery. The distance from the intersection of the right subclavian artery and the CTJP to the origin of the right subclavian artery (ORSA) was measured, and the relationship between this distance and the patient's sex, BMI and height was analyzed.
Seventy-three patients were enrolled, of whom 12 had ORSA above the CTJP, while 61 had ORSA below the plane. There was a significant difference in age between the two groups (p = 0.04), compared with height, weight and BMI (p > 0.05). In 61 patients with the ORSA below the CTJP, the average distance was 24.7 ± 7.6 mm. The difference between the distance and BMI (p = 0.02) was statistically significant, and it was increased with increasing BMI.
The relationship between the ORSA and CTJP can be clarified through 3D reconstruction. The cervical-thoracic recurrent laryngeal nerve lymph nodes can be distinguished clearly in minimally invasive esophagectomy, contributing to the accurate N staging of middle-thoracic esophageal cancer.
本文旨在使用三维（3D）重建系统重建颈胸交界处平面（CTJP）。因此，在手术过程中可以判断 CTJP，以便更好地区分颈胸淋巴结。
我们纳入了 2019 年 12 月至 2020 年 3 月在福建医科大学附属协和医院的患者。所有患者均接受胸部薄层增强 CT 扫描，使用 IQQA 系统（EDDA 技术）进行 3D 重建，以重建 CTJP、头臂干、右颈总动脉和右锁骨下动脉。测量右锁骨下动脉与 CTJP 的交点到右锁骨下动脉起点（ORSA）的距离，并分析该距离与患者性别、BMI 和身高的关系。
共纳入 73 例患者，其中 12 例 ORSA 位于 CTJP 上方，61 例位于 CTJP 下方。两组患者的年龄存在显著差异（p=0.04），而身高、体重和 BMI 无显著差异（p>0.05）。在 61 例 ORSA 位于 CTJP 下方的患者中，平均距离为 24.7±7.6mm。距离与 BMI 的差异具有统计学意义（p=0.02），且随着 BMI 的增加而增加。
通过 3D 重建可以明确 ORSA 与 CTJP 的关系。在微创食管切除术时可以清楚地区分颈胸段喉返神经淋巴结，有助于准确进行中胸段食管癌的 N 分期。
