三维 CT 血管造影有助于单端口胸腔镜解剖性肺切除术治疗肺隔离症：一项回顾性队列研究。
Three-dimensional CT angiography facilitates uniportal thoracoscopic anatomic lung resection for pulmonary sequestration: a retrospective cohort study.
机构信息
Department of General Surgery, Xuzhou Central Hospital, Affiliated Xuzhou Clinical College of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, China.
Department of Thoracic Surgery, Xuzhou Central Hospital, Affiliated Xuzhou Clinical College of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, China.
出版信息
J Cardiothorac Surg. 2022 Aug 30;17(1):218. doi: 10.1186/s13019-022-01975-8.
BACKGROUND
Pulmonary sequestration (PS) is a rare lesion with independent blood supply from an anomalous systemic artery. A timely resection is considered as the best treatment for PS. Three-dimensional computed tomography angiography (3D-CTA) has been widely utilized for precise thoracic surgery. This study aimed to investigate the role of preoperative 3D-CTA and resection simulation in uniportal video-assisted thoracoscopic surgery (VATS) anatomical lung surgery for PS.
METHODS
The data of 20 consecutive PS patents undergoing anatomic lung resection between April 2011 and May 2021 in a single centre were retrospectively reviewed. These patients were divided into the 3D-CTA group (10 patients) and the control group (10 patients) according to the initial surgical planning with or without 3D-CTA. The perioperative parameters regarding safety and fluency such as the incidence of conversion to open thoracotomy, operation time, blood loss, complications and chest tube duration were analyzed.
RESULTS
This cohort included 12 female and 8 male patients, with a mean age of 45 years old (range 24-60 years). Nine cases demonstrated recurrent febrile, cough, or hemoptysis; whereas the other 11 patients were asymptomatic on admission. Eighteen (90.0%) intralobar and 2 extralobar PS were confirmed, whereas 18 (90.0%) lesions were located in the left thorax. The feeding vessels originated from the thoracic aorta in 16 patients (80.0%), the abdominal aorta in 3 (15.0%), and the inferior phrenic artery in 1 patient (5.0%). There was no major bleeding or 30 days mortality. The initial surgical planning included 9 uniportal and 1 two-port VATS in the 3D-CTA group, as compared with 10 two-port VATS in the control group. Thirteen lobectomies, 5 segmentectomies and 2 mass excisions were performed. However, no conversion was needed in the 3D-CTA group; whereas 6 (60.0%) conversions (4 to multiple-port and 2 to thoracotomy) occurred in the control group, indicating a significant difference (P = 0.003). In addition, the operation time in the 3D-CTA group was significantly shorter than those in the control group [(108.5 ± 24.9) min vs. (154.5 ± 39.4) min, P = 0.006]. The other surgery-related outcomes were similar between the two groups.
CONCLUSION
Preoperative 3D-CTA facilitates the safe and fluent performance of uniportal VATS anatomical lung resection for PS with shortened operation time and lessened surgical conversions.
背景
肺隔离症（PS）是一种罕见的病变，具有来自异常体循环动脉的独立血供。及时切除被认为是 PS 的最佳治疗方法。三维计算机断层血管造影（3D-CTA）已广泛应用于精确的胸外科手术。本研究旨在探讨术前 3D-CTA 及切除模拟在单端口电视辅助胸腔镜手术（VATS）解剖性肺手术治疗 PS 中的作用。
方法
回顾性分析 2011 年 4 月至 2021 年 5 月在单一中心接受解剖性肺切除术的 20 例 PS 患者的数据。根据初始手术计划，这些患者被分为 3D-CTA 组（10 例）和对照组（10 例），分别有无 3D-CTA。分析了安全性和流畅性相关的围手术期参数，如中转开胸率、手术时间、出血量、并发症和胸腔引流管时间。
结果
该队列包括 12 名女性和 8 名男性患者，平均年龄 45 岁（范围 24-60 岁）。9 例表现为复发性发热、咳嗽或咯血；而其他 11 例入院时无症状。18 例（90.0%）为叶内型 PS，2 例为叶外型 PS，18 例（90.0%）病变位于左胸。供血动脉来源于胸主动脉 16 例（80.0%），腹主动脉 3 例（15.0%），膈下动脉 1 例（5.0%）。无大出血或 30 天死亡率。3D-CTA 组初始手术计划包括 9 例单端口和 1 例双端口 VATS，对照组为 10 例双端口 VATS。行肺叶切除术 13 例，肺段切除术 5 例，肿块切除术 2 例。然而，3D-CTA 组无需中转开胸；而对照组需要中转 6 例（60.0%），包括 4 例转为多孔和 2 例转为开胸，差异有统计学意义（P=0.003）。此外，3D-CTA 组的手术时间明显短于对照组[（108.5±24.9）min 比（154.5±39.4）min，P=0.006]。两组其他手术相关结果相似。
结论
术前 3D-CTA 有助于安全、流畅地进行单端口 VATS 解剖性肺切除术治疗 PS，可缩短手术时间，减少手术中转。
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