Application of preoperative localization coupled with CT three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Tengteng ,  LIU Baodong , ZHANG Yi , SU Lei , LI Yuanbo , QIAN Kun

Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, P. R. China;

Corresponding?author：

LIU Baodong, Email: xwliubaodong@aliyun.com

Keywords：

Preoperative localization; three-dimensional reconstruction; thoracoscopy; combined subsegmental/segmental resection

DOI：

10.7507/1007-4848.202201012

Video：

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Objective To assess the clinical value of preoperative localization coupled with computed tomography (CT) three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection. Methods The clinical data of 30 patients of combined subsegmental/segmental resection in our hospital from December 2019 to October 2021 were retrospectively collected. There were 19 males and 11 females with the mean age of 56.4 (32.0-71.0) years. The pulmonary nodules were located by CT-guided injection of glue before operation. The three-dimensional reconstruction image and operation planning were carried out by Mimics 21.0 software. Results The operations were all successfully performed, and there was no conversion to open thoracotomy or lobectomy. The mean tumor diameter was 11.6±3.5 mm, the mean distance between the nodule and the visceral pleura was 13.6±5.6 mm, the mean width of the actual cutting edge was 25.0±6.5 mm, the mean operation time was 110.2±23.8 min, the mean number of lymph node dissection stations was 6.5±2.4, the mean amount of intraoperative bleeding was 50.8±20.3 mL, the mean retention time of thoracic catheter was 3.2±1.1 d, and the mean postoperative hospital stay was 4.5±1.7 d. There was 1 patient of subcutaneous emphysema, 1 patient of atrial fibrillation and 1 patient of blood in sputum. Conclusion Preoperative CT-guided injection of medical glue combined with CT three-dimensional reconstruction of pulmonary bronchus and blood vessels is safe and feasible in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection, which ensures the surgical margin and reserves lung tissues.

Citation： WANG Tengteng, LIU Baodong, ZHANG Yi, SU Lei, LI Yuanbo, QIAN Kun. Application of preoperative localization coupled with CT three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 364-368. doi: 10.7507/1007-4848.202201012 Copy

1.	趙俊松, 崔利, 何江波, 等. 上海22 351例無癥狀體檢者低劑量CT肺癌篩查及隨訪結果初步分析. 診斷學理論與實踐, 2019, 18(2): 183-188.
2.	Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
3.	Asamura H, Okada M, Saji H, et al. Randomized trial of segmentectomy compared to lobectomy in small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). The 101st AATS conference. Oral presentation.
4.	錢坤, 支修益, 張毅, 等. CT 引導下注射醫用膠在肺部小結節胸腔鏡術前定位中的應用. 首都醫科大學學報, 2015, 36(4): 529-532.
5.	李元博, 蘇雷, 錢坤, 等. 肺小結節胸腔鏡術前CT引導下注射醫用膠定位的臨床體會. 中國微創外科雜志, 2019, 19(12): 1125-1128.
6.	肺小結節術前輔助定位技術專家共識(2019版)專家組. 肺小結節術前輔助定位技術專家共識(2019版). 中國胸心血管外科臨床雜志, 2019, 26(2): 109-113.
7.	支修益, 劉寶東. 肺癌診治的兩大理念: 微創和精準. 中國微創外科雜志, 2017, 17(1): 1-3.
8.	Gonzalez D, Delgado M, Paradela M, et al. Uni-incisional video-assisted thoracoscopic left lower lobectomy in a patient with an incomplete fissure. Innovations (Phila), 2011, 6(1): 45-47.
9.	Fu R, Zhang JT, Dong S, et al. Drainage tube hole suture improvement: Removal-free stitches. Thorac Cancer, 2019, 10(9): 1827-1833.
10.	任占良, 古軼, 任小朋, 等. 單孔胸腔鏡肺良性疾病術后免胸管的臨床療效及安全性. 中國醫師雜志, 2019, 21(7): 1083-1084.
11.	謝敬廉, 姚維深, 周國華, 等. 單孔胸腔鏡與傳統胸腔鏡肺楔形切除術治療肺部疾病的臨床對比研究. 中國實用醫藥, 2019, 14(34): 4-6.
12.	鐘楚澄, 胡婉玲. 單孔胸腔鏡肺楔形切除術的臨床效果分析. 中外醫療, 2020, 39(34): 22-25.
13.	王鐵功, 金相蘭, 詹茜, 等. CT引導下Hook wire術前定位在15 mm及以下肺結節的應用及預后評估. 中華介入放射學電子雜志, 2020, 8(1): 70-76.
14.	陳進, 吳娟, 胡冰宇, 等. 低劑量CT引導下注射醫用膠在肺結節胸腔鏡切除術前定位中的應用. 現代實用醫學, 2020, 32(9): 1081-1083, 封3.
15.	郭堅溪, 張華, 肖偉俅, 等. 肺結節定位針在肺小結節術前定位的初步臨床研究. 影像診斷與介入放射學, 2020, 29(5): 349-355.
16.	Okada M, Mimae T, Tsutani Y, et al. Segmentectomy versus lobectomy for clinical stage ⅠA lung adenocarcinoma. Ann Cardiothorac Surg, 2014, 3(2): 153-159.
17.	張真榕, 劉德若, 王曉偉, 等. 早期非小細胞肺癌外科治療的薈萃分析. 中日友好醫院學報, 2014, 28(4): 229-233.
18.	Winckelmans T, Decaluwé H, De Leyn P, et al. Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2020, 57(6): 1051-1060.
19.	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. Eur J Cardiothorac Surg, 2014, 46(6): e120-e126.
20.	Kurenov SN, Ionita C, Sammons D, et al. Three-dimensional printing to facilitate anatomic study, device development, simulation, and planning in thoracic surgery. J Thorac Cardiovasc Surg, 2015, 149(4): 973-979.

1. 趙俊松, 崔利, 何江波, 等. 上海22 351例無癥狀體檢者低劑量CT肺癌篩查及隨訪結果初步分析. 診斷學理論與實踐, 2019, 18(2): 183-188.
2. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
3. Asamura H, Okada M, Saji H, et al. Randomized trial of segmentectomy compared to lobectomy in small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). The 101st AATS conference. Oral presentation.
4. 錢坤, 支修益, 張毅, 等. CT 引導下注射醫用膠在肺部小結節胸腔鏡術前定位中的應用. 首都醫科大學學報, 2015, 36(4): 529-532.
5. 李元博, 蘇雷, 錢坤, 等. 肺小結節胸腔鏡術前CT引導下注射醫用膠定位的臨床體會. 中國微創外科雜志, 2019, 19(12): 1125-1128.
6. 肺小結節術前輔助定位技術專家共識(2019版)專家組. 肺小結節術前輔助定位技術專家共識(2019版). 中國胸心血管外科臨床雜志, 2019, 26(2): 109-113.
7. 支修益, 劉寶東. 肺癌診治的兩大理念: 微創和精準. 中國微創外科雜志, 2017, 17(1): 1-3.
8. Gonzalez D, Delgado M, Paradela M, et al. Uni-incisional video-assisted thoracoscopic left lower lobectomy in a patient with an incomplete fissure. Innovations (Phila), 2011, 6(1): 45-47.
9. Fu R, Zhang JT, Dong S, et al. Drainage tube hole suture improvement: Removal-free stitches. Thorac Cancer, 2019, 10(9): 1827-1833.
10. 任占良, 古軼, 任小朋, 等. 單孔胸腔鏡肺良性疾病術后免胸管的臨床療效及安全性. 中國醫師雜志, 2019, 21(7): 1083-1084.
11. 謝敬廉, 姚維深, 周國華, 等. 單孔胸腔鏡與傳統胸腔鏡肺楔形切除術治療肺部疾病的臨床對比研究. 中國實用醫藥, 2019, 14(34): 4-6.
12. 鐘楚澄, 胡婉玲. 單孔胸腔鏡肺楔形切除術的臨床效果分析. 中外醫療, 2020, 39(34): 22-25.
13. 王鐵功, 金相蘭, 詹茜, 等. CT引導下Hook wire術前定位在15 mm及以下肺結節的應用及預后評估. 中華介入放射學電子雜志, 2020, 8(1): 70-76.
14. 陳進, 吳娟, 胡冰宇, 等. 低劑量CT引導下注射醫用膠在肺結節胸腔鏡切除術前定位中的應用. 現代實用醫學, 2020, 32(9): 1081-1083, 封3.
15. 郭堅溪, 張華, 肖偉俅, 等. 肺結節定位針在肺小結節術前定位的初步臨床研究. 影像診斷與介入放射學, 2020, 29(5): 349-355.
16. Okada M, Mimae T, Tsutani Y, et al. Segmentectomy versus lobectomy for clinical stage ⅠA lung adenocarcinoma. Ann Cardiothorac Surg, 2014, 3(2): 153-159.
17. 張真榕, 劉德若, 王曉偉, 等. 早期非小細胞肺癌外科治療的薈萃分析. 中日友好醫院學報, 2014, 28(4): 229-233.
18. Winckelmans T, Decaluwé H, De Leyn P, et al. Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2020, 57(6): 1051-1060.
19. 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. Eur J Cardiothorac Surg, 2014, 46(6): e120-e126.
20. Kurenov SN, Ionita C, Sammons D, et al. Three-dimensional printing to facilitate anatomic study, device development, simulation, and planning in thoracic surgery. J Thorac Cardiovasc Surg, 2015, 149(4): 973-979.

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Application of preoperative localization coupled with CT three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection

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