严煜;周学军;覃文军;王晓谭;杨茗峻;

• 1:南通大学附属医院胸外科
• 2:南通大学附属医院影像科
• 3:东北大学医学影像智能计算教育部重点实验室

摘要(Abstract)：

目的：为获得满意的DeepInsight三维CT支气管血管成像(3D-computed tomography bronchography and angiography, 3D-CTBA)导航效果，观察胸部增强CT不同条件设置对DeepInsight 3D导航软件运行结果的影响。方法：全组434例进行DeepInsight 3D-CTBA手术导航。采用“团注测试法”预注射对比剂获得肺动脉，主动脉“时间-密度”曲线。为掌握增强CT设置条件，首先对41例患者，按“肺动脉峰值”时间8.8、10.3、11.8 s分为3组，收集各组患者的肺动脉峰值-主动脉峰值(V-A)间隔时间，对比剂注射量和CT扫描延时时间，并进行统计学分析，以发现影响3D导航软件运行结果的相关因素。结果：不同肺动脉峰值时间分组对照结果表明，8.8 s组中对比剂用量减少、扫描延时时间缩短与3D导航软件运行结果不满意有关(均P<0.05)。全组434例DeepInsight 3D-CTBA运行血管提取、染色结果满意391例，较满意30例，不满意13例。满意、较满意病例均成功应用于胸腔镜亚肺叶切除手术导航。结论：正确掌握增强CT对比剂用量和扫描延时时间是DeepInsight 3D导航软件运行获取满意3D图像的关键技术因素。DeepInsight 3D-CTBA能为精准亚肺叶切除提供导航保障。

关键词(KeyWords)： DeepInsight胸腔镜微创手术;肺段切除术;亚肺叶切除;三维CT支气管血管成像导航

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 严煜;周学军;覃文军;王晓谭;杨茗峻;

DOI: 10.16424/j.cnki.cn32-1807/r.2022.03.001

参考文献(References)：

• [1]陈亮,朱全.全胸腔镜解剖性肺段切除手术图谱[M].南京:东南大学出版社,2015:14-45.
• [2]GINSBERG R J,RUBINSTEIN L V.Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer[J].Ann Thorac Surg,1995,60(3):615-623.
• [3]野守裕明,冈田守人.肺癌解剖性肺段切除图谱[M].葛棣,译.天津:天津科技翻译出版公司,2017:9-17.
• [4]陈亮,朱全,吴卫兵，等.胸腔镜解剖性肺亚段切除手术图谱[M].南京:东南大学出版社,2021:36-66.
• [5]严煜,周学军,覃文军,等.DeepInsight 3D导航在胸腔镜肺段切除术中的应用[J].南通大学学报(医学版),2019,39(2):128-130.
• [6]HATTORI A,SUZUKI K,TAKAMOCHI K,et al.Prognostic impact of a ground-glass opacity component in clinical stage IA non-small cell lung cancer[J].J Thorac Cardiovasc Surg,2021,161(4):1469-1480.
• [7]SUZUKI K,WATANABE S I,WAKABAYASHI M,et al.Asingle-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer[J].J Thorac Cardiovasc Surg,2022,163(1):289-301.e2.
• [8]SAJI H,OKADA M,TSUBOI M,et al.Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer(JCOG0802/WJOG4607L):a multicentre,openlabel,phase 3,randomised,controlled,non-inferiority trial[J].Lancet,2022,399(10335):1607-1617.
• [9]AOKAGE K,SAJI H,SUZUKI K,et al.A non-randomized confirmatory trial of segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thinsection computed tomography (JCOG1211)[J].Gen Thorac Cardiovasc Surg,2017,65(5):267-272.
• [10]ALTORKI N K,WANG X F,WIGLE D,et al.Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer:posthoc analysis of an international,randomised,phase 3 trial(CALGB/Alliance 140503)[J].Lancet Respir Med,2018,6(12):915-924.
• [11]NCCN Clinical Practice Guidelines Oncology.Non-Small Cell Lung Cancer.中文版(Version 5.2021)[EB/OL].(2021-06-15) https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf.
• [12]KATSUMATA S,AOKAGE K,NAKASONE S,et al.Radiologic criteria in predicting pathologic less invasive lung cancer according to TNM 8th edition[J].Clin Lung Cancer,2019,20(2):e163-e170.
• [13]AOKAGE K,YOSHIDA J,HISHIDA T,et al.Limited resection for early-stage non-small cell lung cancer as function-preserving radical surgery:a review[J].Jpn J Clin Oncol,2017,47(1):7-11.
• [14]SHIMIZU K,NAGASHIMA T,OHTAKI Y,et al.Analysis of the variation pattern in right upper pulmonary veins and establishment of simplified vein models for anatomical segmentectomy[J].Gen Thorac Cardiovasc Surg,2016,64(10):604-611.
• [15]CHAN E G,LANDRENEAU J R,SCHUCHERT M J,et al.Preoperative(3-dimensional) computed tomography lung reconstruction before anatomic segmentectomy or lobectomy for stage I non-small cell lung cancer[J].J Thorac Cardiovasc Surg,2015,150(3):523-528.
• [16]TAN W J,HUANG P F,LI X S,et al.Analysis of segmentation of lung parenchyma based on deep learning methods[J].J X Ray Sci Technol,2021,29(6):945-959.
• [17]TAN W J,LIU P,LI X S,et al.Segmentation of lung airways based on deep learning methods[J].IET Image Process,2022,16(5):1444-1456.
• [18]WU W B,XU X F,WEN W,et al.Thoracoscopic pulmonary sub-subsegmentectomy based on three-dimensional images[J].Ann Thorac Surg,2016,102(5):e389-e391.
• [19]WU W B,XU X F,WEN W,et al.Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy[J].J Thorac Dis,2016,8(Suppl 9):S710-S715.
• [20]WU W B,XIA Y,PAN X L,et al.Three-dimen sional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules[J].Thorac Cancer,2019,10(1):41-46.
• [21]WU W B,HE Z C,XU J,et al.Anatomical pulmonary sublobar resection based on subsegment[J].Ann Thorac Surg,2021,111(6):e447-e450.
• [22]单一波,蒋薛伟,黄斌,等.3D技术在早期肺癌围手术期的应用进展[J].中华胸心血管外科杂志,2020,36(7):434-437.