Department of Thoracic Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China.
BMC Surg. 2023 May 19;23(1):139. doi: 10.1186/s12893-023-02034-2.
To investigate the feasibility and safety of watershed analysis after target pulmonary vascular occlusion for the wedge resection in patients with non-palpable and non-localizable pure ground-glass nodules during uniport thoracoscopic surgery.
A total of 30 patients with pure ground-glass nodules < 1 cm in diameter, localized in the lateral third of the lung parenchyma, were enrolled. Three-dimensional reconstruction of thin-section computed tomography (CT) data was performed using Mimics software before surgery to observe and identify the target pulmonary vessels supplying the lung tissue in the area where the pulmonary nodules were localized and to temporarily block the target pulmonary vessels during surgery. Next, the extent of the watershed was determined with the expansion-collapse method, and finally, wedge resection was performed. After wedge resection of the target lung tissue, the blocked pulmonary vessel was released, thus allowing operators to complete the procedure without damaging pulmonary vessels.
None of the patients experienced postoperative complications. The chest CT of all patients was reviewed six months after the operation, revealing no tumor recurrence.
Our results suggest that watershed analysis following target pulmonary vascular occlusion for wedge resection in pulmonary pure ground-glass nodules is a safe and feasible approach.
探讨在单孔胸腔镜手术中，对无法触及和定位的纯磨玻璃结节患者，行楔形切除术时，在目标肺血管阻断后行流域分析的可行性和安全性。
术前使用 Mimics 软件对直径<1cm、位于肺实质外侧三分之一、局限性纯磨玻璃结节的 30 例患者的薄层 CT 数据进行三维重建，观察并识别定位肺结节区域的目标肺血管，并在术中暂时阻断目标肺血管。然后，采用膨胀-收缩法确定流域范围，最后行楔形切除术。在切除目标肺组织后，松开阻塞的肺血管，使术者能够在不损伤肺血管的情况下完成手术。
所有患者均未发生术后并发症。所有患者术后 6 个月复查胸部 CT，未见肿瘤复发。
我们的结果表明，在目标肺血管阻断后行流域分析行楔形切除术治疗肺部纯磨玻璃结节是一种安全可行的方法。
