Liu Bo, Wang Kebing, Ye Si
Technol Health Care. 2025;33(1):195-203. doi: 10.3233/THC-240786.
Accurately identifying the branches of pulmonary segmental vessels and bronchi, as well as adjacent structures, and determining the spatial location of lesions within pulmonary segments, are major challenges for thoracic surgeons. The application of three-dimensional reconstruction technology holds promise in addressing this issue.
To evaluate the clinical value of three-dimensional reconstruction in thoracoscopic segmental surgery.
Seventy-seven patients who underwent thoracoscopic segmental surgery combined with three-dimensional reconstruction at our hospital from January 1, 2020, to August 31, 2023, were retrospectively analyzed. Preoperative chest enhanced CT scans were conducted, and MIMICS software aided in reconstructing DICOM format original data for patients with pulmonary nodules to facilitate intraoperative nodule localization. Accurate segmental pneumonectomy was performed by comparing preoperative anatomical identification of target segmental arteries, veins, and bronchi, with surgical details and postoperative outcomes recorded, including intraoperative pulmonary resection distribution, operation time, blood loss, chest tube drainage, extubation time, hospital stay, and complications.
Following preoperative three-dimensional reconstruction, successful segmental lung surgeries were performed, predominantly with single segmental resection (92.2%), and a minority with combined segmentectomy (7.8%). Median operation time was 130225 minutes, with intraoperative blood loss at 70100 mL and postoperative chest tube drainage at 347 mL (159690 mL). Median extubation time and hospital stay were 4 days and 7 days, respectively. Complications within the 3-month follow-up affected 11.7% of cases, including persistent pulmonary leakage (7.1%), pulmonary infection (4.3%), atelectasis (4.3%), and pleural effusion (1.4%), with no fatalities.
Preoperative 3D reconstruction can help the operator to perform safe, efficient and accurate thoracoscopic segmental pneumonectomy, which is worth popularizing in clinic.
准确识别肺段血管和支气管的分支以及相邻结构，并确定肺段内病变的空间位置，是胸外科医生面临的主要挑战。三维重建技术的应用有望解决这一问题。
评估三维重建在胸腔镜肺段手术中的临床价值。
回顾性分析2020年1月1日至2023年8月31日在我院接受胸腔镜肺段手术联合三维重建的77例患者。术前行胸部增强CT扫描，利用MIMICS软件对肺结节患者的DICOM格式原始数据进行重建，以利于术中结节定位。通过比较术前对目标段动脉、静脉和支气管的解剖识别，进行准确的肺段切除术，并记录手术细节和术后结果，包括术中肺切除分布、手术时间、出血量、胸腔闭式引流量、拔管时间、住院时间和并发症。
术前三维重建后，成功实施了肺段手术，主要为单肺段切除（92.2%），少数为联合肺段切除（7.8%）。中位手术时间为130（225）分钟，术中出血量为70（100）毫升，术后胸腔闭式引流量为347（159，690）毫升。中位拔管时间和住院时间分别为4天和7天。3个月随访期内的并发症发生率为11.7%，包括持续性肺漏气（7.1%）、肺部感染（4.3%）、肺不张（4.3%）和胸腔积液（1.4%），无死亡病例。
术前三维重建有助于术者安全、高效、准确地实施胸腔镜肺段切除术，值得临床推广。
