胸腔镜解剖性肺段切除术技术要点

由于肺段支气管、血管的解剖变异繁多,胸腔镜肺段切除术的技术较肺叶切除术更加精细复杂。术前三维CT支气管血管成像（three dimensional-computed tomography bronchography and angiography,3D-CTBA）可以显示肺段的解剖结构以及肺段支气管、血管的变异,明确肺部结节的肺段归属,有助于制定手术计划。术前结节定位在胸腔镜肺段切除术中起着重要作用。解剖性肺段切除术的技术包括：分别切断靶段动脉、支气管、段内静脉,保留段间静脉,采用膨胀萎陷法确定肺段间交界面,使用电刀和/或切割缝合器分离段间肺组织。恶性结节行肺段切除术时必须确保切缘宽度≥2 c...

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Bibliographic Details
Published inZhongguo fei ai za zhi Vol. 19; no. 6; pp. 377 - 381
Main Author 陈亮 吴卫兵
Format Journal Article
LanguageChinese
English
Published 天津市和平区南京路228号300020 南京医科大学第一附属医院胸外科,南京,210029 20.06.2016
中国肺癌杂志编辑部
Subjects
3D-CT
Special Topics on Early Stage Lung Cancer
支气管及血管造影
肺段切除术
胸腔镜
3D-CT
胸腔镜
hToracoscopy
支气管及血管造影
Pulmonary segmentectomy
Bronchogra-phy and angiography
肺段切除术
hTree-dimensional computed tomography
Online AccessGet full text
ISSN1009-3419
1999-6187
DOI10.3779/j.issn.1009-3419.2016.06.16

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Summary:由于肺段支气管、血管的解剖变异繁多,胸腔镜肺段切除术的技术较肺叶切除术更加精细复杂。术前三维CT支气管血管成像（three dimensional-computed tomography bronchography and angiography,3D-CTBA）可以显示肺段的解剖结构以及肺段支气管、血管的变异,明确肺部结节的肺段归属,有助于制定手术计划。术前结节定位在胸腔镜肺段切除术中起着重要作用。解剖性肺段切除术的技术包括：分别切断靶段动脉、支气管、段内静脉,保留段间静脉,采用膨胀萎陷法确定肺段间交界面,使用电刀和/或切割缝合器分离段间肺组织。恶性结节行肺段切除术时必须确保切缘宽度≥2 cm,或≥肿瘤直径,同时需要进行N1、N2站淋巴结采样及冰冻切片分析。胸腔镜解剖性肺段切除术的并发症发生率较低。肺段与肺叶的解剖关系为,若干个呈不规则锥形结构的肺段组成一个肺叶,段间静脉行走于肺段间。本中心探索出一种按照锥形结构原理自肺叶中分离出肺段的方法,并命名为＂锥式肺段切除术＂。＂锥式肺段切除术＂的技术涵盖了准确判断和处理靶段支气管和血管以及解剖性分离段间交界面,可以实现精准的肺段切除。
Bibliography:Thoracoscopy; Pulmonary segmentectomy; Three-dimensional computed tomography; Bronchography and angiography
Thoracoscopic segmentectomy is technically much more meticulous than lobectomy, due to the complicated anotomical variations of segmental bronchi and vessels. Preoperative three-dimensional computed tomography bronchography and angiography, 3D-CTBA） could reveal the anatomical structures and variations of the segmental bronchi/vessels and locate the pulmonary nodules, which is helpful for surgery planning. Preoperative nodule localization is of vital importance for thoracoscopic segmentectomy. Techniques involved in this procedure include dissection of the targeted arteries, bronchus and intra-segmental veins, retention of the inter-segmental veins, identification of the inter-segmental boarder with the inflation-deflation method and seperation of intra-segmental pulmonary tissues by electrotome and/or endoscopic staplers. The incision margin for malignant nodules should be at least 2 cm or the diameter
ISSN:1009-3419
1999-6187
DOI:10.3779/j.issn.1009-3419.2016.06.16