Demarcation of arteriopulmonary segments: a novel and effective method for the identification of pulmonary segments

ObjectiveEach pulmonary segment is an anatomical and functional unit. However, it is fundamentally difficult to precisely distinguish every pulmonary segment using the conventional pulmonary intersegmental planes from computed tomography images. Building arteriopulmonary segments is likely to be an effective way to identify pulmonary segments.MethodsThe thoracic computed tomography images of 40 patients were collected. The anatomic structures of interest were extracted in the transverse, sagittal, and coronal planes using the semi-automated segmentation tools provided by Amira software. The intrapulmonary vessels were subsequently segmented and reconstructed. The distributions of the pulmonary arteries, veins, and bronchi were observed. In patients with pulmonary masses, the mass was also reconstructed.ResultsThe three-dimensional reconstructed images showed the branches of the pulmonary artery ramified up to their eighth order covering the entire lung as well as evident intersegmental gaps without pulmonary arteries. The segmental artery was closely accompanied by the segmental bronchi in 486 pulmonary segments (90% of total number of segments). The size and spatial location of the pulmonary mass within a pulmonary segment were also clearly visible.ConclusionsDemarcation of arteriopulmonary segments can be used to precisely distinguish every pulmonary segment and provide its detailed anatomical structure before pulmonary segmentectomy.     

CO2 laser in cancer surgery of the breast: a comparative clinical study

Review of the literature reveals little to no data regarding the use of the CO2 laser as a surgical modality in the local treatment of breast cancer. This study was undertaken to determine if the CO2 laser is a surgical improvement over the scalpel, influencing patient care during the surgical and postsurgical period. In the author's series, a total of 209 procedures were performed. Within this group, 105 cases were performed with CO2 laser and 104 cases performed with the scalpel. Biopsies were always performed as a separate procedure prior to definitive surgery. This study was not designed to compare cure rates, the medical follow-up period being 1 year. The results of this study demonstrate a significant improvement in patients' postoperative care, surgical technique, and hospital cost-effectiveness.     

胸腔镜肺段切除术的临床结果分析

目的分析胸腔镜肺段切除术的临床结果,探讨胸腔镜肺段切除手术需要关注的临床问题,为更好开展胸腔镜肺段切除手术及减少围手术期并发症提供参考。方法回顾性分析我科2017年10月至2019年12月开展的计划行胸腔镜肺段切除手术90例患者的临床资料,其中男35例,平均年龄(60.34±9.40)岁;女55例,平均年龄(56.09±12.11)岁。比较患者临床资料,包括肺结节数量及良恶性情况、术前Hook-wire定位情况、术前规划和具体实施的术式、手术时间、术中出血量、术后引流量及引流管放置时间、术后住院时间及术后并发症等,总结经验教训。结果计划行胸腔镜下肺段切除的90例患者中,术前Hook-wire定位38例、直接手术52例;在胸腔镜下完成手术87例、中转开胸3例。中转开胸患者中有1例行肺叶切除术,胸腔镜下有3例在完成肺段切除术后被动行肺叶切除手术。全组患者平均手术时间(198.58±56.42)min,术中出血量(129.78±67.51)mL,淋巴结采样数量(6.43±1.41)枚,术后引流管放置时间(2.98±1.25)d,术后引流量(480.00±262.00)mL,术后住院时间(7.60±2.38)d。90例患者中,单发结节患者73例、多发结节患者17例。共切除肺结节113枚,其中良性结节14枚、恶性结节99枚,恶性占比为87.61%。无围手术期死亡及严重并发症。结论对符合指征的肺实质内结节,根据术前薄层CT及三维CT支气管血管重建结果做好规划,可采用胸腔镜解剖性肺段切除术;对肺段间结节、不易扪及的外周纯磨玻璃结节,术前采用Hook-wire定位可保证有效切缘并减少非计划肺叶切除术。     

不同VATS切除术式对T1期NSCLC患者手术相关临床指标、肺功能及炎症反应水平的影响

目的:探讨VATS肺段和VATS肺叶切除术式对T1期NSCLC患者手术相关临床指标、肺功能及炎症反应水平的影响。方法:研究对象选取我院2015年6月至2017年6月收治T1期NSCLC患者共130例，根据手术方案不同分为肺叶切除组（65例）和肺段切除组（65例），分别采用VATS肺段和VATS肺叶切除术式治疗；比较两组患者手术相关临床指标水平、手术前后肺功能指标、炎症反应实验室指标水平及术后并发症发生率。结果:肺叶切除组患者手术操作时间和术中失血量均显著优于肺段切除组（P<0.05）；肺段切除组患者术后引流量、术后引流时间及总住院时间均显著优于肺叶切除组（P<0.05）；两组患者淋巴结数量比较差异无统计学意义（P>0.05）；肺段切除组患者术后肺功能指标水平均显著高于肺叶切除组（P<0.05）；肺段切除组患者术后炎症反应实验室指标水平均显著低于肺叶切除组（P<0.05）；两组患者术后并发症发生率比较差异无统计学意义（P>0.05）。结论:相较于VATS肺叶切除术式，VATS肺段切除术式治疗T1期NSCLC可有效加快病情康复进程，保护肺部通气功能，并有助于抑制术后全身炎症反应；而VATS肺叶切除术式则能够缩短手术用时，降低医源性创伤程度。     

Fluorescence visualization of the intersegmental plane by bronchoscopic instillation of indocyanine green into the targeted segmental bronchus: determination of the optimal settings

ObjectiveTo determine the appropriate amount of indocyanine green for bronchial insufflation.MethodsWe enrolled 20 consecutive patients scheduled for anatomical segmentectomy in the Kochi Medical School Hospital. After inducing general anesthesia, 6 to 60 mL of 200-fold-diluted indocyanine green (0.0125 mg/mL) was insufflated into the subsegmental bronchi in the targeted pulmonary segmental bronchus. The volume of the targeted pulmonary segments was calculated using preoperative computed tomography. Fluorescence spread in the segmental alveoli was visualized using a dedicated near-infrared thoracoscope.ResultsThe targeted segment was uniformly visualized by indocyanine green fluorescence in 16/20 (80.0%) cases after insufflating indocyanine green. A receiver operating characteristic curve indicated that the area under the curve was 0.984; the optimal cut-off volume of diluted indocyanine green for insufflation was 8.91% of the calculated targeted pulmonary segment volume.ConclusionsThe setting for indocyanine green insufflation was optimized for near-infrared fluorescence image-guided anatomical segmentectomy. By injecting the correct amount of indocyanine green, fluorescence-guided anatomical segmentation may be performed more appropriately.     

Surgical modality for stage IA non-small cell lung cancer among the elderly: analysis of the Surveillance,Epidemiology, and End Results database

BackgroundThe appropriate surgical modality for early-stage non-small cell lung cancer (NSCLC) among the elderly remains controversial; identifying appropriate modalities will be helpful in clinical practice.MethodsIt’s a cohort study and we explored the Surveillance, Epidemiology, and End Results (SEER) database for identifying patients aged ≥70 years with pathologic stage IA NSCLC. Three types of surgeries were compared (lobectomy, segmentectomy, and wedge resection) via survival and stratification analyses.ResultsOverall, 6,197 patients were enrolled. Among patients aged ≥76 years with tumor diameters ≤1 cm, significant differences in survival were noted for segmentectomy vs. lobectomy [hazard ratio (HR) =0.294, P=0.007] and wedge resection vs. lobectomy (HR =0.548, P=0.017) but not in those with tumors diameters >1 cm. Among patients aged 70–75 years with tumor diameters >1–2 cm, significant differences in survival were observed for segmentectomy vs. lobectomy (HR =0.671, P=0.037) and segmentectomy vs. wedge resection (HR =0.556, P=0.003) and for wedge resection vs. lobectomy (HR =1.283, P=0.003) among those with tumor diameters >2–3 cm but not in those with tumor diameters ≤1 cm.ConclusionsBoth age and tumor size should be considered when selecting the surgical modality. Lobectomy is not recommended for lesions ≤1 cm among patients aged ≥76 years. Segmentectomy was associated with superior prognosis for tumor diameters >1–2 cm and survival favored lobectomy rather than wedge resection for NSCLCs >2–3 cm among patients aged 70–75 years. Surgeons could rely on personal experience to determine the appropriate surgical modality for NSCLCs >1 cm among patients aged ≥76 years and NSCLCs ≤1 cm among patients aged 70–75 years.     

腹腔镜解剖性肝段切除术治疗肝细胞癌的临床分析

目的 探讨腹腔镜解剖性肝段切除术治疗肝细胞癌的临床疗效.方法 回顾性分析2011年1月至2014年4月西南医院肝胆外科采用腹腔镜解剖性肝段切除术治疗的29例肝细胞癌患者临床资料.结果 29例患者中3例中转开腹,中转开腹率为10.3％,26例成功施行腹腔镜解剖性肝段切除术,切除部位例数分别为:Ⅰ段3例、Ⅱ段2例、Ⅲ段3例、Ⅳ段4例、Ⅴ段6例、Ⅵ段7例、Ⅶ段2例、Ⅷ段2例.手术时间(220.17±61.56) min,术中出血量(311.72±127.70) mL,围手术期输血率3.44％,肿瘤直径(3.66±1.14)cm,切缘(2.11 ±0.87) cm,术后开始进食时间(1.69 ±0.71)d,术后住院时间(8.72±2.95)d,围手术期无死亡病例,术后并发症发生率为10.3％.术后病理检查均为肝细胞肝癌,其中高分化癌6例、中分化癌20例、低分化癌3例.29例患者均获得随访,随访时间为12～48个月,中位随访时间为26个月.术后1、3年总体生存率分别为92.8％、81.7％,无瘤生存率分别为89.5％、71.7％.将本研究病例按切除部位分为左前下段组(Ⅱ/Ⅲ/Ⅳb/Ⅴ/Ⅵ段)(19例)与后上段组(Ⅰ/Ⅳa/Ⅶ/Ⅷ段)(10例),对比提示两组手术时间、术中失血量、肝门阻断率、肝门阻断时间、术后住院时间差异有统计学意义(P＜0.05),而围手术期输血率、中转开腹率、术后开始进食时间、切缘、并发症发生率差异无统计学意义(P＞0.05).两组1、3年总体生存率及无瘤生存率差异无统计学意义.结论 在选择性病例中,腹腔镜解剖性肝段切除术治疗肝细胞肝癌安全、可行,近期效果好、早期复发率低,且初步证实腹腔镜解剖性肝段切除术不仅适用于左前下段肝癌的治疗,亦可运用于手术难度和风险较大的后上段肝癌的外科治疗.     

全胸腔镜解剖性肺段切除术12例报告

目的 探讨全胸腔镜肺段切除术的可行性、安全性及手术适应证.方法 2011年3月～2013年3月我院行胸腔镜解剖性肺段切除术12例,采用标准完全胸腔镜肺叶切除切口,按照解剖学依次用钉高2.5 mm 白色钉仓处理肺段动脉、肺段静脉,用钉高3.5 mm 蓝色钉仓处理支气管,同时进行系统淋巴结清扫.结果 12例均顺利完成胸腔镜解剖性肺段切除术,无中转开胸及辅助小切口.手术时间115～260 min,平均182 min;术中出血量100～300 ml,平均230 ml.胸腔引流时间2～6 d,平均3.5 d.术后住院3～11 d,平均7.5 d.无二次手术,无输血,无围手术期死亡.术后病理：腺癌6例,鳞癌2例,转移癌2例,炎性假瘤1例,结核球1例,其中原发非小细胞肺癌均为Ⅰa期.12例随访1～24个月,平均9个月,10例肺癌均无复发、转移.结论 全胸腔镜解剖性肺段切除术对于Ⅰa 期非小细胞肺癌及肺功能差或有其他合并症而不适合行肺叶切除者,是一种安全可行的选择.