Asada Y, Suzuki T, Fujino S, Kato H, Mori A
Second Department of Surgery, Shiga University of Medical Science, Otsu, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Feb;45(2):119-29.
To evaluate changes after Lobectomy in the regional functions of the remaining lung and of the unaffected lung, three-dimensional (3-D) images of lung ventilation and perfusion SPECT were studied. In 60 patients who underwent lung resection, ventilation (99m Tc-phytate aerosol inhalation) and perfusion (99m Tc-MAA) SPECT were performed before and one month after operation. 3-D images were obtained from SPECT by the volume-rendering method setting thresholds at three levels, and the 3-D functional capacity of the right and left lung was determined at a threshold of 25%. Changes were evaluated using the ratio of the value obtained after operation to the one obtained before operation. The remaining rate of perfusion in the remaining lung was 0.58 +/- 0.22 after the right upper lobectomy, 0.32 +/- 0.04 after the right upper & middle bilobectomy, 0.86 +/- 0.11 after the right middle lobectomy, 0.55 +/- 0.17 after the right lower lobectomy, 0.24 +/- 0.18 after the left upper lobectomy, 0.46 +/- 0.05 after the left lower lobectomy, and 0 after the left pneumonectomy. The remaining rate was significantly low in the right upper & middle bilobectomy and the left upper lobectomy. The large decrease in the rate in these operations was considered to have resulted from a shift of the remaining lung towards the head and excessive expansion of the remaining lung. The distribution of the aerosol inhalation decreased more significantly than that of perfusion in almost all patients. The remaining rate of ventilation of the remaining lung after the lower lobectomy was lower than that after the upper lobectomy. This may have been due to the characteristics of the aerosol practices. We found that changes in the regional functions of the lung after lung resection can be topographically and quantitatively evaluated by 3-D image processing of pulmonary ventilation and perfusion SPECT, such analysis is usefulness in evaluation of function preservation operation.
为评估肺叶切除术后余肺及健肺区域功能的变化，对肺通气和灌注单光子发射计算机断层扫描（SPECT）的三维（3-D）图像进行了研究。在60例行肺切除的患者中，于术前及术后1个月进行了通气（99m锝-植酸盐气溶胶吸入）和灌注（99m锝-大颗粒聚合人血清白蛋白）SPECT检查。通过容积再现法在三个水平设置阈值从SPECT获得3-D图像，并在25%的阈值下确定左右肺的3-D功能容量。使用术后获得的值与术前获得的值之比来评估变化。右上叶切除术后余肺的灌注残留率为0.58±0.22，右上中双叶切除术后为0.32±0.04，右中叶切除术后为0.86±0.11，右下叶切除术后为0.55±0.17，左上叶切除术后为0.24±0.18，左下叶切除术后为0.46±0.05，左全肺切除术后为0。右上中双叶切除术和左上叶切除术中残留率显著较低。这些手术中该比率的大幅下降被认为是由于余肺向头侧移位及余肺过度扩张所致。几乎所有患者中，气溶胶吸入的分布比灌注的分布下降更显著。下叶切除术后余肺的通气残留率低于上叶切除术后。这可能是由于气溶胶操作的特点所致。我们发现，通过肺通气和灌注SPECT的3-D图像处理可以在地形学和定量方面评估肺切除术后肺区域功能的变化，这种分析在评估功能保留手术方面是有用的。
