背景:探讨在单孔胸腔镜手术中不可触及且不可定位的纯磨玻璃结节患者进行楔形切除的目标肺血管阻塞后分水岭分析的可行性和安全性。
方法:共30例直径<1cm的纯磨玻璃结节,位于肺实质的外侧三分之一,已注册。术前利用Mimics软件对薄层计算机断层扫描(CT)数据进行三维重建,观察和识别肺结节定位区域肺组织供血的靶肺血管,并在手术过程中暂时阻断靶肺血管。接下来,分水岭的范围是用膨胀-塌陷法确定的,最后,楔形切除术。楔形切除靶肺组织后,阻塞的肺血管被释放,因此,允许操作者在不损伤肺血管的情况下完成手术。
结果:没有患者出现术后并发症。所有患者术后6个月复查胸部CT,未发现肿瘤复发。
结论:我们的结果表明,在肺纯磨玻璃结节楔形切除术中,目标肺血管阻塞后的分水岭分析是一种安全可行的方法。
BACKGROUND: To investigate the feasibility and safety of watershed analysis after target pulmonary vascular occlusion for the wedge resection in patients with non-palpable and non-localizable pure ground-glass nodules during uniport thoracoscopic surgery.
METHODS: A total of 30 patients with pure ground-glass nodules < 1 cm in diameter, localized in the lateral third of the lung parenchyma, were enrolled. Three-dimensional reconstruction of thin-section computed tomography (CT) data was performed using Mimics software before surgery to observe and identify the target pulmonary vessels supplying the lung tissue in the area where the pulmonary nodules were localized and to temporarily block the target pulmonary vessels during surgery. Next, the extent of the watershed was determined with the expansion-collapse method, and finally, wedge resection was performed. After wedge resection of the target lung tissue, the blocked pulmonary vessel was released, thus allowing operators to complete the procedure without damaging pulmonary vessels.
RESULTS: None of the patients experienced postoperative complications. The chest CT of all patients was reviewed six months after the operation, revealing no tumor recurrence.
CONCLUSIONS: Our results suggest that watershed analysis following target pulmonary vascular occlusion for wedge resection in pulmonary pure ground-glass nodules is a safe and feasible approach.