Matsuoka Shunichiro, Eguchi Takashi, Seshimoto Maho, Mishima Shuji, Hara Daisuke, Kumeda Hirotaka, Miura Kentaro, Hamanaka Kazutoshi, Shimizu Kimihiro
Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
JTCVS Tech. 2023 Dec 15;23:92-103. doi: 10.1016/j.xjtc.2023.11.021. eCollection 2024 Feb.
To optimize surgical outcomes and minimize complications in complex segmentectomy of the left upper lobe, we investigated the topographical anatomy of the left upper lobe and developed a segmentectomy-oriented anatomical model.
A state-of-the-art 3-dimensional computed tomography workstation was used to visualize the intersegmental planes and associated veins to categorize the anatomical patterns influencing surgical procedures during left upper lobe segmentectomy. This included the central vein affecting S (apicoposterior segment) segmentectomy, the transverse S (anterior segment) affecting S segmentectomy, and other venous branching patterns in 395 patients who underwent thoracic surgery at our institution.
The central vein was observed in 32% of the patients, necessitating access from the interlobar area after segmental artery and bronchus division. Transverse S incidence was 27%, revealing that only one-third of the patients required complete left upper lobe transection between S and S during S segmentectomy. A significant negative correlation was observed between the presence of transverse S and the central vein (<10% of patients with the central vein had transverse S and vice versa). In 6% of patients, the lingular segmental veins partially or entirely drained into the inferior pulmonary vein, potentially causing excessive or insufficient resection during surgery.
This study offers valuable insights into the topographic anatomy of the left upper lobe and presents a segmentectomy-oriented anatomical model for complex segmentectomies. Our approach enables a more precise and individualized surgical planning for patients undergoing segmentectomy based on their unique anatomy, which could thereby lead to improved patient outcomes.
为了优化左肺上叶复杂肺段切除术的手术效果并减少并发症，我们研究了左肺上叶的局部解剖结构，并建立了一种以肺段切除术为导向的解剖模型。
使用先进的三维计算机断层扫描工作站来可视化肺段间平面和相关静脉，以对影响左肺上叶肺段切除术手术过程的解剖模式进行分类。这包括影响S（尖后段）肺段切除术的中央静脉、影响S（前段）肺段切除术的横行S以及在我们机构接受胸外科手术的395例患者中的其他静脉分支模式。
32%的患者观察到中央静脉，这需要在切断肺段动脉和支气管后从叶间区域进入。横行S的发生率为27%，这表明在S肺段切除术中只有三分之一的患者需要在S和S之间完全横断左肺上叶。观察到横行S和中央静脉之间存在显著的负相关（中央静脉患者中<10%有横行S，反之亦然）。6%的患者中，舌段静脉部分或全部汇入下肺静脉，这可能导致手术中切除过多或不足。
本研究为左肺上叶的局部解剖结构提供了有价值的见解，并提出了一种用于复杂肺段切除术的以肺段切除术为导向的解剖模型。我们的方法能够根据患者独特的解剖结构为接受肺段切除术的患者进行更精确和个性化的手术规划，从而可能改善患者的手术效果。
