基于CT三维重建技术对肺部病变患侧肺段支气管解剖类型及变异情况的影像学观察

doi:10.3760/cma.j.cn101202-20221008-00302

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摘要目的探讨基于CT三维重建影像的肺部病变患者病灶侧肺段支气管的解剖类型与变异情况。方法横断面研究。纳入2019年12月—2022年8月新疆医科大学第一附属医院胸外科行胸部薄层增强CT扫描的615例患者的影像资料,其中男250例、女365例,年龄38~70岁（中位年龄58岁）。615例患者中,肺癌488例,肺结核及肺部其他炎性病变127例。CT检查显示病变部位：右肺359例,其中右肺上叶205例、中叶43例、下叶111例;左肺256例,其中左肺上叶184例、下叶72例。根据患者CT扫描数据重建患侧肺支气管和血管,观察统计患侧各肺段支气管的解剖类型及解剖变异情况。结果（1）右肺359例：a）右肺上叶支气管解剖类型分为3种类型,两分支型105例（29.2%）、三分支型233例（64.9%）、四分支型11例（3.1%）;三分支型中的B¹,B²,B³亚型215例（59.9%）是右肺上叶支气管最常见的解剖类型。此外,观察到10例（2.8%）少见解剖变异。b）右肺中叶支气管解剖类型分为3种类型,两分支型343例（95.5%）、三分支型15例（4.2%）、四分支型1例（0.3%）;两分支型中的B⁴,B⁵亚型332例（92.5%）是右肺中叶支气管最常见的解剖类型。此外,发现27例（7.5%）右肺中叶B⁴,B⁵空间位置关系类似于左肺上叶B⁴,B⁵亚型。c）右肺下叶背段支气管解剖类型分为3种类型,单分支型353例（98.3%）、双分支型5例（1.4%）、三分支型1例（0.3%）;单分支型又分为双分叉亚型248例（69.1%）、三分叉亚型105例（29.2%）,其中双分叉亚型中B⁶b,B⁶a+c型114例（31.8%）是右肺下叶背段支气管最常见的解剖类型。右肺下叶内侧基底段支气管分为6种亚型,其中B⁷a型215例（59.9%）最常见。右肺下叶前侧、外侧、后侧基底段支气管解剖类型分为4种类型,其中B⁸,B⁹+B¹⁰型261例（72.7%）最常见。右肺下叶发现星段支气管（B^*）124例（34.5%）,根据B^*分支数目分为单分支型114例（31.7%）,双分支型10例（2.8%）;根据B^*起始部位分为3种亚型,其中B⁸,B^*+B⁹+B¹⁰亚型88例（24.5%）最常见。（2）左肺256例：a）左肺上叶固有段支气管解剖类型分为3种类型,两分支型165例（64.4%）、三分支型90例（35.2%）、四分支型1例（0.4%）;两分支型分为8种亚型,其中（B¹⁺²a+b,B¹⁺²c）,（B³a,B³b+c）亚型116例（45.3%）是左肺上叶固有段支气管最常见的解剖类型。左肺上叶舌段支气管解剖类型分为2种类型,两分支型249例（97.3%）,三分支型7例（2.7%）;两分支型分为4种亚型,其中的B⁴,B⁵亚型182例（71.7%）是左肺上叶舌段支气管最常见的解剖类型。此外,发现56例（21.9%）左肺上叶B⁴,B⁵型空间位置关系类似于右肺中叶B⁴,B⁵型。b）左肺下叶背段支气管解剖类型分为3种类型,单分支型254例（99.2%）、两分支型1例（0.4%）、三分支型1例（0.4%）;单分支型又分为双分叉型164例（64.0%）、三分叉型89例（34.8%）、四分叉型1例（0.4%）3种亚型,三分叉亚型中的B⁶a,B⁶b,B⁶c型85例（33.2%）是左肺下叶背段支气管最常见的解剖类型。左肺下叶前、外、后侧基底段支气管解剖类型分为3种类型,其中B⁸,B⁹+B¹⁰型148例（57.8%）最常见;此外,观察到左肺下叶B⁷从基底干单独分支19例（7.4%）。另外,观察到左肺下叶B^*95例（37.1%）,根据B^*分支数目分为单分支型78例（30.5%）,双分支型17例（6.6%）;根据B^*起始部位分为5种亚型,其中B⁸,B^*+B⁹+B¹⁰亚型52例（20.3%）最常见。结论肺部病变侧肺段和亚段支气管解剖类型复杂多样且存在罕见解剖变异,相关手术和操作前应充分熟悉相应支气管的分支类型,避免术中误判、误伤。

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关键词 ：支气管, 解剖, 体层摄影术, 螺旋计算机, 三维重建

Abstract：Objective This study aimed to investigate the anatomical types and variations of segmental bronchi on the side of pulmonary lesions based on CT three-dimensional reconstruction. Methods The cross-sectional study was conducted The imaging data of 615 patients who underwent chest thin-layer enhanced CT examination in the Department of Thoracic Surgery, the First Affiliated Hospital of Xinjiang Medical University from December 2019 to August 2022 were included, including 250 males and 365 females, aged 38-70 years (median age=58 years). Among the 615 patients, 488 cases were lung cancer, and 127 were tuberculosis and inflammation. CT examination showed that the lesions were located in the right lung in 359 cases, including 205 cases in the upper lobe, 43 in the middle lobe, and 111 in the lower lobe. A total of 256 cases were left lung, including 184 of left upper lobe and 72 of left lower lobe. The bronchi and blood vessels of the affected lung were reconstructed according to the CT scan data of the patients. The anatomical types and anatomical variations of bronchi of each segment of the lung on the affected side were observed and counted. Results (1) A total of 359 cases were right lung. a) The anatomical types of the right upper-lobe bronchus were divided into three types: 105 (29.2%) of double-branch type, 233 (64.9%) of triple branch, and 11 (3.1%) of quadruple branch. Among the three branch types, the B¹,B²,B³ subtype was the most common anatomical type in the upper lobe of the right lung, with 215 cases (59.9%). Moreover, 10 cases (2.8%) of rare anatomical variations were observed. b) The anatomical types of the right middle-lobe bronchus were divided into three types: 343 (95.5%) of double branch, 15 (4.2%) of triple branch, and 1 (0.3%) of quadruple branch. Among the two branch types, the B⁴,B⁵ subtype (332 cases, 92.5%) was the most common anatomical type of the right middle-lobe bronchus. In 27 cases (7.5%), the spatial relationship of the B⁴,B⁵ type in the right middle lobe was similar to that of the B⁴,B⁵ type in the left upper lobe. c) The anatomical types of the superior segment of the right lower-lobe bronchus were divided into three types: single (353 cases, 98.3%), double (5 cases, 1.4%), and three (1 case, 0.3%) branch types. The single-branch type was further divided into double-bifurcation (248 cases, 69.1%) and triple-bifurcation (105 cases, 29.2%) subtypes. Among the double-bifurcation subtypes, the B⁶b,B⁶a+c type (114 cases, 31.8%) was the most common anatomical type of the superior segment of the right lower-lobe bronchus. The mediobasal segmental bronchus of the right lower lobe was divided into six subtypes, among which the B⁷a type was the most common (215 cases, 59.9%). The anatomical types of the ventrobasal, lateralbasal, and dorsobasal segmental bronchus of the right lower lobe were divided into four types, among which the B⁸,B⁹+B¹⁰ type was the most common type (261 cases, 72.7%). The subsuperior segmental bronchus (B^*) was found in the right lower lobe in 124 cases (34.5%). According to the number of B^* branches, 114 (31.7%) were single branch and 10 (2.8%) were double branch. According to the origin site of B^*, the patients were divided into three subtypes, among which the B⁸,B^*+B⁹+B¹⁰ type was the most common (88 cases, 24.5%). (2) A total of 256 cases were left lung. a) The anatomical types of the proper segment bronchus of the left upper lobe were divided into three types: 165 (64.4%) of double branch, 90 (35.2%) of triple branch, and 1 (0.4%) of quadruple branch. The two branches were divided into eight subtypes, among which the (B¹⁺²a+b,B¹⁺²c),(B³a,B³b+c) type was the most common anatomical type in the proper segment of the left upper-lobe bronchus (116 cases, 45.3%). The anatomical types of the lingual bronchus in the upper lobe of the left lung were divided into two types, 249 (97.3%) of double branch and 7 (2.7%) of triple branch. The two branches were divided into four subtypes, among which the B⁴,B⁵ type was the most common anatomical type (182 cases, 71.7%). In 56 cases (21.9%), the spatial relationship of the B⁴,B⁵ type in the left upper lobe was similar to the B⁴,B⁵ type in the right middle lobe. b) The anatomical types of the superior segment bronchus of the left lower lobe were divided into three types: 254 (99.2%) of single branch, 1 (0.4%) of double branch, and 1 (0.4%) of triple branch. The single-branch type was further divided into three subtypes: double branch (164 cases, 64.0%), triple branch (89 cases, 34.8%), and quadruple branch (1 case, 0.4%). Among the triple-branch subtypes, the B⁶a,B⁶b,B⁶c type was the most common anatomical type in the superior segment of the left lower lobe of the lung (85 cases, 33.2%). The anatomical types of the ventrobasal, lateralbasal, and dorsobasal segmental bronchus of the left lower lobe were divided into three types, among which the B⁸,B⁹+B¹⁰ type was the most common (148 cases, 57.8%). A separate branch of B⁷ from the basal trunk was observed in 19 cases (7.4%). Furthermore, 95 cases (37.1%) of B* were observed in the lower lobe of the left lung. According to the number of B* branches, 78 (30.5%) were single branch and 17 (6.6%) were double branch. Five subtypes existed according to the B* origin site, among which B⁸,B*+B⁹+B¹⁰ subtype was the most common in 52 cases (20.3%). Conclusion The anatomical types of segmental and subsegmental bronchi on the side of lung lesions are complex and diverse, and anatomical variations are rare. Thus, being completely familiar with the branch types of the corresponding bronchi before related operations is necessary to avoid misjudgment and accidental injury during operation.

Key words： Bronchi Dissection Tomography spiral computed Three-dimensional reconstruction

收稿日期: 2022-10-08

通讯作者: 张海平,Email：pulmonarysurgery@163.com

引用本文:

胡义, 阿卜拉·努尔麦麦提, 穆热迪力·麦麦提阿卜杜拉, 张力为, 张海平. 基于CT三维重建技术对肺部病变患侧肺段支气管解剖类型及变异情况的影像学观察[J]. 中华解剖与临床杂志, 2023, 28(6): 365-375.
Hu Yi, Nurmamat Abla, Mamatabdulla Muradil, Zhang Liwei, Zhang Haiping. Observation of the anatomical types and variations of pulmonary segment bronchus on the side of pulmonary lesions based on multi-slice spiral CT three-dimensional reconstruction technique. Chinese Journal of Anatomy and Clinics, 2023, 28(6): 365-375.

链接本文:

http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20221008-00302 或 http://www.cjac.com.cn/CN/Y2023/V28/I6/365

[1]	Sung H, Ferlay J, Siegel RL, et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021,71(3):209-249. DOI: 10.3322/caac.21660
[2]	Saji H, Okada M, Tsuboi M, et al.Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial[J]. Lancet, 2022, 399(10335): 1607-1617. DOI:10.1016/S0140-6736(21)02333-3
[3]	Suzuki K, Saji H, Aokage K, et al.Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial[J]. J Thorac Cardiovasc Surg, 2019,158(3):895-907. DOI: 10.1016/j.jtcvs.2019.03.090
[4]	Liu A, Wang Z, Yang Y, et al.Preoperative diagnosis of malignant pulmonary nodules in lung cancer screening with a radiomics nomogram[J]. Cancer Commun (Lond), 2020,40(1):16-24. DOI: 10.1002/cac2.12002
[5]	范坤,冯锦腾,王泓懿,等.基于三维重建的肺小结节患者右上肺叶解剖研究[J].中华胸心血管外科杂志,2020,36(9):557-561. DOI:10.3760/cma.j.cn112434-20200817-00376.Fan K, Feng JT, Wang HY, et al.Anatomy of upper lung lobes of patients with small pulmonary nodules based on three-dimensional reconstruction of PC[J]. Chin J Thorac Cardiovasc Surg, 2020, 36(9): 557-561. DOI:10.3760/cma.j.cn112434-20200817-00376
[6]	Hagiwara M, Shimada Y, Kato Y, et al.High-quality 3-dimensional image simulation for pulmonary lobectomy and segmentectomy: results of preoperative assessment of pulmonary vessels and short-term surgical outcomes in consecutive patients undergoing video-assisted thoracic surgery[J]. Eur J Cardiothorac Surg, 2014,46(6):e120-126. DOI: 10.1093/ejcts/ezu375
[7]	Murota M, Yamamoto Y, Satoh K, et al.Preoperative evaluation of the right upper lobe pulmonary artery by 3D-CT pulmonary angiography thin-section multiplanar reconstruction images obtained by contrast-enhanced multidetector-row CT[J]. Acta Med Okayama, 2015, 69(6): 327-332. DOI:10.18926/AMO/53906
[8]	Fourdrain A, De Dominicis F, Bensussan M, et al.Three-dimensional computed tomography angiography of the pulmonary veins and their anatomical variations: involvement in video-assisted thoracoscopic surgery-lobectomy for lung cancer[J]. Folia Morphol (Warsz), 2017,76(3):388-393. DOI: 10.5603/FM.a2016.0081
[9]	陈亮,朱全,吴卫兵,等. 胸腔镜解剖性肺亚段切除手术图谱[M]. 南京:东南大学出版社, 2021: 63
[10]	Nagashima T, Shimizu K, Ohtaki Y, et al.Analysis of variation in bronchovascular pattern of the right middle and lower lobes of the lung using three-dimensional CT angiography and bronchography[J]. Gen Thorac Cardiovasc Surg, 2017,65(6):343-349. DOI: 10.1007/s11748-017-0754-4
[11]	陈凯,张亚杰,项捷,等. CT三维重建辅助达芬奇机器人解剖性肺段切除术的临床应用[J].中华解剖与临床杂志,2020,25(3):260-264. DOI:10.3760/cma.j.cn101202-20190612-00194.Chen K, Zhang YJ, Xiang J, et al.Three-dimensional computed tomography reconstruction in robotic-assisted thoracoscopic anatomic pulmonary segmentectomy[J]. Chin J Anat Clin, 2020, 25(3): 260-264. DOI: 10.3760/cma.j.cn101202-20190612-00194
[12]	Yao F, Wang J, Yao J, et al.Three-dimensional image reconstruction with free open-source OsiriX software in video-assisted thoracoscopic lobectomy and segmentectomy[J]. Int J Surg, 2017,39:16-22. DOI: 10.1016/j.ijsu.2017.01.079
[13]	Sardari Nia P, Olsthoorn JR, Heuts S, et al.Interactive 3D reconstruction of pulmonary anatomy for preoperative planning, virtual simulation, and intraoperative guiding in video-assisted thoracoscopic lung surgery[J]. Innovations (Phila), 2019,14(1):17-26. DOI: 10.1177/1556984519826321
[14]	Zhang J, Zhu Y, Li H, et al.VATS right posterior segmentectomy with anomalous bronchi and pulmonary vessels: a case report and literature review[J]. J Cardiothorac Surg, 2021,16(1):60. DOI: 10.1186/s13019-021-01420-2
[15]	Andolfi M, Potenza R, Seguin-Givelet A, et al.Identification of the intersegmental plane during thoracoscopic segmentectomy: state of the art[J]. Interact Cardiovasc Thorac Surg, 2020, 30(3): 329-336. DOI: 10.1093/icvts/ivz278
[16]	Yamashita H.Variations in the pulmonary segments and the bronchovascular trees. Roentgenologic anatomy of the lung[M]. Tokyo: Igaku-syoin, 1978: 70-107
[17]	Nagashima T, Shimizu K, Ohtaki Y, et al.An analysis of variations in the bronchovascular pattern of the right upper lobe using three-dimensional CT angiography and bronchography[J]. Gen Thorac Cardiovasc Surg, 2015, 63(6): 354-360. DOI: 10.1007/s11748-015-0531-1
[18]	Deng Y, Cai S, Huang C, et al.Anatomical variation analysis of left upper pulmonary blood vessels and bronchi based on three-dimensional reconstruction of chest CT[J]. Front Oncol, 2022,12: 1028467. DOI: 10.3389/fonc.2022.1028467
[19]	Ghaye B, Szapiro D, Fanchamps JM, et al.Congenital bronchial abnormalities revisited[J]. Radiographics, 2001,21(1):105-119. DOI: 10.1148/radiographics.21.1.g01ja06105
[20]	Maki R, Miyajima M, Ogura K, et al.Pulmonary vessels and bronchial anatomy of the left lower lobe[J]. Surg Today, 2020,50(9):1081-1090. DOI: 10.1007/s00595-020-01991-y