Long Tao, Qi Junqing, Shao Aizhong, Zhu Jingfeng, Pan Huiwen, Shi Yijun, Ren Zhengbing, He Zhicheng, Wu Weibing
Department of Cardiothoracic Surgery, Affiliated People's Hospital of Jiangsu University, Zhenjiang, China.
Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
J Thorac Dis. 2025 Jan 24;17(1):174-186. doi: 10.21037/jtd-24-1397. Epub 2025 Jan 22.
Sublobar surgeries involving the left anterior segment of the lung can be challenging due to its central location within the left upper lobe (LUL) and among multi-segments. However, there have been no reports specifically analysing the anatomical patterns of this segment. Therefore, this study aimed to comprehensively investigate the subsegmental bronchovascular patterns and relationship between variations and surgical strategies.
The branching patterns of the left anterior segment bronchi and pulmonary vessels were assessed retrospectively and categorised using three-dimensional reconstruction images of 647 consecutive patients.
Anatomical distribution patterns of the left anterior segmental bronchus, artery, and vein analysed in 635 valid cases were 6, 38, and 6, respectively. For the first time, branches of the sub-subsegmental level were demonstrated and reclassified in the anterior segment. Additionally, all 102 cases (16.06%) of interlobar (IL) arterial variations were found in the lateral subsegmental artery. Interestingly, only the lateral subsegmental artery patterns were not independent of the types associated with the anterior segmental bronchus, artery, and vein in the left upper division. Based on the observed anatomical variant patterns of the artery and bronchus, we developed a decision-making theory to assist in selecting surgical approaches for nodules located within the lateral subsegment of the anterior segment of the lung.
The study elucidated the sub-subsegmental level of the left anterior segmental bronchovascular distribution patterns. This study also indicated a correlation between the lateral subsegmental arterial patterns and the patterns observed in the anterior bronchus and the left upper division vein (LUDV). By taking these findings on arterial and bronchial variations into account preoperatively, we might contribute to formulating a more concise operation procedure and optimizing the selection of surgical approaches.
由于左肺前段位于左上叶中央且处于多个肺段之间，涉及该部位的肺叶下部分切除术具有挑战性。然而，尚无专门分析该肺段解剖模式的报道。因此，本研究旨在全面探究亚段支气管血管模式以及变异与手术策略之间的关系。
回顾性评估647例连续患者的三维重建图像，对左肺前段支气管和肺血管的分支模式进行分析并分类。
在635例有效病例中分析的左肺前段支气管、动脉和静脉的解剖分布模式分别为6种、38种和6种。首次在前段展示并重新分类了亚亚段水平的分支。此外，所有102例（16.06%）叶间动脉变异均发现于外侧亚段动脉。有趣的是，仅外侧亚段动脉模式与左上叶前段支气管、动脉和静脉相关类型不独立。基于观察到的动脉和支气管解剖变异模式，我们制定了一种决策理论，以协助选择位于肺前段外侧亚段内结节的手术入路。
本研究阐明了左肺前段支气管血管分布模式的亚亚段水平。该研究还表明外侧亚段动脉模式与前支气管和左上叶静脉（LUDV）观察到的模式之间存在相关性。术前考虑这些动脉和支气管变异的发现，可能有助于制定更简洁的手术操作流程并优化手术入路的选择。
