CT三维重建技术辅助胸腔镜扩大肺亚段切除术治疗肺段边缘孤立性结节的短期疗效观察

doi:10.3760/cma.j.cn101202-20230628-00166

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摘要目的探讨支气管、血管CT三维重建技术（3D-CTBA）辅助胸腔镜扩大肺亚段切除术治疗肺段边缘孤立性结节的短期疗效。方法回顾性队列研究。纳入2017年8月—2022年8月在徐州市肿瘤医院接受手术治疗的肺段边缘结节患者60例,其中男21例、女39例,年龄23~79（51.7±10.1）岁。根据手术方式不同分组：肺段组30例,采用3D-CTBA辅助胸腔镜扩大肺段切除术;肺亚段组30例,采用3D-CTBA辅助胸腔镜扩大肺亚段切除术。观察指标：（1）比较2组围术期指标,包括手术时间、术中出血量、切缘宽度、术后胸腔引流量及引流管留置时间、住院时间;（2）比较2组患者术前和术后6个月肺功能指标,包括用力肺活量（FVC）、每分钟最大通气量（MVV）、第一秒用力呼吸量（FEV₁）;（3）比较2组患者术后6个月内并发症发生率,以及复发、转移及死亡情况。结果 60例患者均顺利完成手术,无中转开放手术。2组患者性别、年龄、肺结节直径和部位等基线资料比较,差异均无统计学意义（P值均>0.05）。肺亚段组手术时间为（123.6±28.1） min,较肺段组的（96.5±31.9） min更长,术中出血量为（50.3±16.1） mL,较肺段组的（67.1±13.6） mL更少,差异均有统计学意义（t=3.49、4.36,P值均<0.01）;2组切缘宽度、术后胸腔引流量及引流管留置时间、住院时间比较,差异均无统计学意义（P值均>0.05）。（2）术后6个月与术前相比,2组FVC、MVV及FEV₁水平均下降,组间比较肺段组各指标水平更低,差异均有统计学意义（P值均<0.001）。（3）2组患者的并发症发生率、复发、转移及死亡情况比较,差异均无统计学意义（P值均>0.05）。结论 3D-CTBA引导下胸腔镜扩大肺亚段切除术治疗肺段边缘孤立性结节安全可行,相比于3D-CTBA引导下胸腔镜扩大肺段切除术,虽然该术式手术时间相对延长,但减少了术中出血量,对肺功能影响小,且不增加并发症风险。

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关键词 ：肺肿瘤, 孤立性肺结节, 三维重建, 胸腔镜, 扩大肺亚段切除术, 肺段边缘结节

Key words： Lung neoplasms Solitary pulmonary nodule Three-dimensional reconstruction Thoracoscope Extended subsegmentectomy Marginal lung nodule

收稿日期: 2023-06-28

基金资助:徐州市双创计划（徐人才办[2017]10号）

通讯作者: 高杰, Email:gaojie6564@163.com

引用本文:

常鹏, 侯予龙, 公正, 江海城, 李健, 刘译阳, 高杰. CT三维重建技术辅助胸腔镜扩大肺亚段切除术治疗肺段边缘孤立性结节的短期疗效观察[J]. 中华解剖与临床杂志, 2024, 29(2): 120-123.
Chang Peng, Hou Yulong, Gong Zheng, Jiang Haicheng, Li Jian, Liu Yiyang, Gao Jie. Short-term curative effect of thoracoscopic extended subsegmentectomy under the assistance of 3D-CTBA on marginal solitary pulmonary nodules. Chinese Journal of Anatomy and Clinics, 2024, 29(2): 120-123.

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