CT三维重建联合术中肺自然萎陷定位在胸腔镜肺段切除术中的初步探讨 Translated title: Preliminary Study of CT Three-dimensional Reconstruction Combined with Ground Glass Nodules of Natural Lung Collapse in Thoracoscopic Pulmonary Segmental Resection

Abstract

背景与目的

计算机断层扫描（computed tomography, CT）三维重建技术越来越多地被应用于肺磨玻璃结节（ground glass nodule, GGN）肺癌患者术前规划中，但术中如何准确定位结节和保证安全切除边缘依然是临床医生面对的难题。本研究旨在探讨全胸腔镜下肺段切除术中，CT三维重建联合术中肺自然萎陷定位方法的准确性、便捷性及切缘的安全性。

方法

选取2019年7月-2019年12月收治入院的45例影像学表现有肺GGN的患者为研究组，45例患者均接受薄层CT扫描并术前进行三维重建，于麻醉后快速打开胸腔小操作口和患者气道，利用压强差使肺快速自然萎陷，根据自然标志线进行GGN定位，3-0 prolene线标记，然后行三维重建指导下的胸腔镜肺段切除术。标本摘除后测量GGN与缝线标识的距离、GGN与切缘的距离并常规送检切缘。统计患者一般临床资料、病理资料与术后并发症，并与同期采用hookwire定位针进行定位的连续45例患者进行比较。

结果

CT三维重建联合术中无创式肺自然萎陷GGN定位，平均定位时间为6.9 min，定位准确率为90.6%。术中发现广泛胸腔粘连2例，肺气肿1例。术后病理均证实为肺腺癌，切缘送检均呈阴性。肺段切除后均无严重并发症的发生。

结论

CT三维重建联合术中肺自然萎陷GGN定位，缩短了术中寻找GGN的时间，保障了切缘的安全性，是一种更经济、实惠、便捷的定位方法，使肺段切除更加精准。

Translated abstract

Background and objective

Computed tomography (CT) three-dimensional reconstruction technology is increasingly used in preoperative planning of patients with ground glass nodule (GGN), but how to accurately locate the nodule and ensure the safe resection edge is still a difficult problem for clinicians. The purpose of this study was to investigate the accuracy, convenience and safety of CT three-dimensional reconstruction combined with intraoperative natural collapse localization in total thoracoscopic segmental pneumonectomy.

Methods

A total of 45 patients with radiographic findings of pulmonary GGN admitted from July 2019 to December 2019 were selected as the study group. All patients received thin-slice CT scan and underwent preoperative three-dimensional reconstruction. After anesthesia, the small thoracic operation opening and the airway of the patients were quickly opened, and the lung was rapidly and naturally collapsed by pressure difference. GGN were positioned according to the natural marker line, and marked with 3-0 prolene line. After specimen removal, the distance between the GGN and the suture mark, the distance between the GGN and the incision margin were measured, and the incision margin was routinely examined. The general clinical data, pathological data and postoperative complications were counted and compared with 45 consecutive patients who were located with hookwire positioning needle in the same period.

Results

The average localization time of non-invasive GGN with natural lung collapse during operation was 6.9 min, and the localization accuracy was 90.6%. There were 2 cases of extensive pleural adhesion and 1 case of emphysema. Postoperative pathology was confirmed as lung adenocarcinoma, and the examination of incision margin was negative. No GGNs were scanned again after surgery, and the precise resection rate of lung segment was 100.0%.

Conclusion

CT three-dimensional reconstruction combined with GGN localization of natural lung collapse during operation can shorten the time of searching for GGN during operation and guarantee the safety of the incision margin. It is a more economical and convenient localization method and makes pulmonary segment resection more accurate.