Terada Yasuji, Aoyama Akihiro
Department of General Thoracic Surgery, Misugikai Sato Hospital, Hirakata, Japan.
Respiratory Disease Center, Kyoto Katsura Hospital, Kyoto, Japan.
Multimed Man Cardiothorac Surg. 2025 Jan 10;2025. doi: 10.1510/mmcts.2024.103.
The plane running between two adjacent pulmonary segments consists of a very thin layer of connective tissue through which the pulmonary vein also runs. To perform an anatomically correct segmentectomy, this segmental plane needs to be divided. Before the operation, the locations of vessels and bronchi are confirmed by three-dimensional computed tomography. A 4-cm minithoracotomy skin incision is made in the fourth intercostal space on the antero-axillary line, and two ports are added for the scope and the assistant surgeon. Dissection is performed bluntly with confirmation of the pulmonary vein. If the segment is divided along the anatomically correct segmental plane, the pulmonary parenchyma in the residual segments is not compressed by the stapler and inflates fully without deformity. The divided intersegmental planes fit together completely, thereby closing small air leaks. The goal of a segmentectomy is to preserve the pulmonary parenchyma to retain its function. However, resection of a central segment such as the ventral segment (S3) of the left upper lobe by the stapler leaves small shrunken segments and markedly reduces the volume of the residual lung. An anatomically correct segmentectomy by blunt dissection can be performed with correct division of the segmental plane, and no fibrin glue or biomaterial sheets may be necessary.Introduction The goal of a segmentectomy is to preserve the pulmonary parenchyma to maintain its function. However, resection of a central segment such as S3 of the left upper lobe by a stapler leaves small shrunken segments and markedly reduces the volume of the residual lung. To perform an anatomically correct segmentectomy, the segmental plane needs to be divided by blunt dissection with confirmation of the pulmonary vein. If the segment is divided along the anatomically correct segmental plane, the pulmonary parenchyma in the residual segments will not be compressed and will fully inflate without deformity. Air leakage from the segmental plane can be corrected with absorbable thread sutures, and any small air leaks are closed due to the close fitting of the divided intersegmental planes.
相邻两个肺段之间的平面由一层非常薄的结缔组织构成,肺静脉也穿行其中。为了进行解剖学上正确的肺段切除术,需要划分这个肺段平面。手术前,通过三维计算机断层扫描确认血管和支气管的位置。在腋前线第四肋间做一个4厘米的小开胸皮肤切口,并增加两个端口用于放置胸腔镜和辅助外科医生操作。在确认肺静脉的情况下进行钝性分离。如果沿着解剖学上正确的肺段平面进行分割,剩余肺段中的肺实质不会被吻合器压缩,并且能够完全膨胀而不发生变形。分割后的肺段间平面完全贴合在一起,从而封闭小的漏气处。肺段切除术的目标是保留肺实质以维持其功能。然而,用吻合器切除左上叶的中央段(如腹段S3)会留下小的萎缩段,并显著减少剩余肺的体积。通过钝性分离进行解剖学上正确的肺段切除术,在正确划分肺段平面的情况下可以完成,可能不需要使用纤维蛋白胶或生物材料片。
引言 肺段切除术的目标是保留肺实质以维持其功能。然而,用吻合器切除左上叶的S3等中央段会留下小的萎缩段,并显著减少剩余肺的体积。为了进行解剖学上正确的肺段切除术,需要在确认肺静脉的情况下通过钝性分离来划分肺段平面。如果沿着解剖学上正确的肺段平面进行分割,剩余肺段中的肺实质不会被压缩,并且能够完全膨胀而不发生变形。肺段平面的漏气可以用可吸收缝线进行修复,并且由于分割后的肺段间平面紧密贴合,任何小的漏气都会被封闭。