Min Weiwei, Zhang Jianbin, Zhu Yilv, Jin Lili
Department of Thoracic Surgery, Huzhou Central Hospital, Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, 1558 Third Ring North Road, Huzhou, 313000, Zhejiang, China.
Department of Thoracic Surgery, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, 313000, Zhejiang, China.
J Cardiothorac Surg. 2025 Jun 24;20(1):271. doi: 10.1186/s13019-025-03515-6.
This retrospective study aimed to summarize the application of 3-dimensional(3D) reconstruction via modified pulmonary artery computed tomography angiography(CTA), as well as to compare the surgical outcomes of 3D versus high resolution CT(HRCT) in anatomic pulmonary segmentectomy(APS).
A total of 93 patients who underwent thoracoscopic APS were enrolled in the study. They were divided into 3D group (n = 30) and HRCT group (n = 63), and than matched at 1:1 ratio using the propensity score matching (PSM) method. Clinical characteristics, surgical status, and postoperative recovery were compared between two groups, additionally, variations of segmental structures were summarized.
60 cases were matched by PSM with 30 cases in each group. There were no significant differences between two groups in clinical characteristics, intraoperative blood loss and postoperative recovery (including total chest drainage, length of postoperative hospital stay)(P > 0.05 for all). 8(26.7%) patients in 3D group manifesting unique variations of segmental structures underwent anatomical segmentectomy accurately. Despite the 3D group exhibited higher anatomic variations compared to the HRCT group, it demonstrated shorter operation times and lower incidence of pulmonary infection. (P < 0.05 for all).
Preoperative 3D reconstruction has advantages in APS, particularly for patients with complex anatomic variations. Reconstruction via modified pulmonary artery CTA is also feasible for preoperative planning and intraoperative navigation in thoracoscopic APS.
本回顾性研究旨在总结经改良肺动脉计算机断层扫描血管造影（CTA）进行三维（3D）重建的应用情况，并比较3D与高分辨率CT（HRCT）在解剖性肺段切除术（APS）中的手术效果。
本研究共纳入93例行胸腔镜APS的患者。将他们分为3D组（n = 30）和HRCT组（n = 63），然后采用倾向评分匹配（PSM）方法以1:1的比例进行匹配。比较两组患者的临床特征、手术情况和术后恢复情况，此外，总结节段结构的变异情况。
通过PSM匹配60例，每组30例。两组患者在临床特征、术中出血量和术后恢复情况（包括胸腔总引流量、术后住院时间）方面均无显著差异（所有P>0.05）。3D组中有8例（26.7%）表现出独特节段结构变异的患者准确地接受了解剖性肺段切除术。尽管3D组与HRCT组相比显示出更高的解剖变异，但手术时间更短，肺部感染发生率更低。（所有P<0.05）。
术前3D重建在APS中具有优势，特别是对于解剖变异复杂的患者。经改良肺动脉CTA进行重建对于胸腔镜APS的术前规划和术中导航也是可行的。
