Division of Chest Surgery, Hyogo Cancer Center, 13-70, kitaoji-cho, Akashi, Japan.
Department of General Thoracic Surgery, Kobe University Hospital, 7-5-2, Kusunokicho, chuo ward, Kobe, Japan.
Eur J Cardiothorac Surg. 2022 Nov 3;62(6). doi: 10.1093/ejcts/ezac537.
Two methods are available to identify the intersegmental plane during segmentectomy: the inflation-deflation method, based on the ventilation area, and injection of indocyanine green, based on the pulmonary arterial distribution. However, whether the intersegmental plane created by these 2 methods matches remains unknown. Our goal was to identify the demarcation lines based on bronchial and arterial territories using 3-dimensional computed tomography-based volumetry.
We collected data from patients who underwent thoracoscopic segmentectomy in our hospital between April 2012 and May 2021. Three-dimensional images were reconstructed from the preoperative contrast-enhanced computed tomography data using the SYNAPSE VINCENT software program. The volume of the affected area and the distance of the tumour from the intersegmental plane were calculated based on each affected artery and bronchus. Each calculated volume was compared to each affected segment using a paired t-test.
Of 195 patients, 114 underwent upper lobe segmentectomy, and 81 underwent lower lobe segmentectomy. In upper lobe segmentectomy, the affected arterial segmental volume was smaller than the bronchial volume (505.0 ml vs 539.4 ml, P < 0.001). In lower lobe segmentectomy, there was no significant difference between arterial and bronchial volumes (234.6 ml vs 236.9 ml, P = 0.607). The volume of the affected arterial segmental lung and the distance of the tumour from the intersegmental plane were significantly smaller than the bronchial volume in upper lobe segmentectomies.
As per the results, the affected segmental volume delineated by the indocyanine green method would be underestimated in upper lobe segmentectomy.
节段切除术有两种方法可用于识别节段间平面：基于通气面积的膨胀-收缩法和基于肺动脉分布的吲哚菁绿注射法。然而，这两种方法所创建的节段间平面是否匹配尚不清楚。我们的目标是使用基于三维计算机断层扫描的体积测量法，根据支气管和动脉区域识别分界线。
我们收集了 2012 年 4 月至 2021 年 5 月期间在我院接受胸腔镜节段切除术的患者数据。使用 SYNAPSE VINCENT 软件程序从术前增强 CT 数据重建三维图像。根据受累动脉和支气管计算受累区域的体积和肿瘤距节段间平面的距离。使用配对 t 检验对每个计算出的体积与每个受累节段进行比较。
在 195 例患者中，114 例行上叶节段切除术，81 例行下叶节段切除术。在上叶节段切除术，受累动脉节段体积小于支气管体积（505.0ml 比 539.4ml，P<0.001）。在下叶节段切除术，动脉和支气管体积之间无显著差异（234.6ml 比 236.9ml，P=0.607）。上叶节段切除术受累动脉节段肺的体积和肿瘤距节段间平面的距离明显小于支气管体积。
根据结果，在上叶节段切除术，吲哚菁绿法界定的受累节段体积可能被低估。
