右上叶支气管分支模式与容积测量：对肺段切除术规划的影响

Bronchial branching patterns and volumetry in the right upper lobe: impact on segmentectomy planning.

作者信息

Miura Kentaro, Eguchi Takashi, Ide Shogo, Mishima Shuji, Matsuoka Shunichiro, Takeda Tetsu, Hamanaka Kazutoshi, Shimizu Kimihiro

机构信息

Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.

出版信息

Interdiscip Cardiovasc Thorac Surg. 2023 Sep 2;37(3). doi: 10.1093/icvts/ivad136.

DOI:10.1093/icvts/ivad136

PMID:37589657

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10702455/

Abstract

OBJECTIVES

The use of segmentectomy is expected to increase. However, understanding of the segmental bronchial branching is limited. Herein, we aimed to investigate bronchial branching pattern complexity and segmental volumetry of the right upper lung lobe to develop an accurate understanding of segmental anatomy and contribute to the advancement of safe and efficient lung segmentectomy.

METHODS

We evaluated chest computed tomography scans of 303 patients and categorized the branching of segmental bronchi (segment 1, apical; segment 2, posterior; and segment 3, anterior) into 4 major types (typical trifurcated, bifurcated non-defective, bifurcated defective and atypical trifurcated) and 11 subtypes. Segmental volumetry was performed to determine the predominant segment in each case (volume difference <5% was considered equal). Branching complexity was evaluated separately for volumetry-predominant and volumetry-non-predominant segments.

RESULTS

Trifurcated non-defective was the most frequent branching type (64.4%), followed by bifurcated non-defective (22.1%), bifurcated defective (8.6%) and trifurcated half-defective (4.0%). In terms of segmental volumetry, most cases had a one-segment-predominant distribution (71%) and only 5% of cases had equal distribution (segment 1 = segment 2 = segment 3). More than half of the cases had a segment 3-predominant distribution (52%). Branching complexity analysis revealed that the volumetry-non-predominant segment was associated with a higher risk of complex branching patterns compared with the volumetry-predominant segment (37% vs 19%, respectively; P < 0.005).

CONCLUSIONS

Volumetric assessment of the right upper lobe showed a heterogeneous segmental volume distribution. Care should be taken during lung segmentectomy of the volumetry-non-predominant segments because of the high risk associated with complex bronchial branching patterns.

CLINICAL TRIAL REGISTRATION

No. 4840.

摘要

目的

肺段切除术的应用有望增加。然而，对肺段支气管分支的了解有限。在此，我们旨在研究右上肺叶的支气管分支模式复杂性和肺段容积，以准确理解肺段解剖结构，并推动安全、高效的肺段切除术的发展。

方法

我们评估了303例患者的胸部计算机断层扫描，将肺段支气管分支（1段，尖段；2段，后段；3段，前段）分为4种主要类型（典型三叉型、二叉无缺陷型、二叉缺陷型和非典型三叉型）和11种亚型。进行肺段容积测定以确定每种情况下的主要肺段（容积差异<5%视为相等）。分别对容积占优和非占优肺段的分支复杂性进行评估。

结果

三叉无缺陷型是最常见的分支类型（64.4%），其次是二叉无缺陷型（22.1%）、二叉缺陷型（8.6%）和三叉半缺陷型（4.0%）。在肺段容积方面，大多数病例具有一个占主导地位的肺段分布（71%），只有5%的病例具有相等分布（1段 = 2段 = 3段）。超过一半的病例具有3段占主导地位的分布（52%）。分支复杂性分析显示，与容积占优肺段相比，容积非占优肺段出现复杂分支模式的风险更高（分别为37%和19%；P < 0.005）。