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Objective:To investigate the effects of 3D video thoracoscopic surgery combined with 3D CTBA (three-dimensional computed tomography bronchography and angiography) method in clinical education practice of the undergraduates.Methods:The study included in 60 undergraduate clinical interns from our hospital, and they were randomly divided into the experimental group ( n=30) and control group ( n=30). The teaching content was diagnosis and surgical treatment of lung cancer. The experimental group applied 3D video thoracoscopic surgery combined with 3D CTBA teaching method. The interns studied the anatomy of lung and diagnosis of lung cancer based on the 3DCTBA and visited the operation of lung cancer under 3D thoracoscopy, which enhanced their knowledge of anatomical structure of lung. The control group applied traditional thoracoscopic surgery for lung cancer. Upon termination of clinic practice, all interns were tested with theoretical and clinical knowledge of lung cancer. A questionnaire survey was conducted among them to access the teaching effect. SPSS 18.0 was used for t test and chi-square test. Results:The scores of theory test were not significantly different between two groups. The scores of anatomic and operational knowledge of lung in the experimental group were significantly higher compared with the control group ( P<0.05). Questionnaire result showed that new teaching method could promote the interest in learning, motivated the desire for thoracic surgery, and improved the comprehension of clinical knowledge. More students approved the new teaching method. Conclusion:The new method, 3D video thoracoscopic surgery combined with 3D CTBA, has beneficial effect on clinical interns, which contributes to inspire the motivation and interest of learning and deepen clinic knowledge, and is a promising teaching method worthy of further exploration and application.
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@#More and more relevant research results show that anatomical segmentectomy has the same effect as traditional lobectomy in the surgical treatment of early-stage non-small cell lung cancer (diameter<2.0 cm). Segmentectomy is more difficult than lobotomy. Nowadays, with the promotion of personalization medicine and precision medicine, three-dimensional technique has been widely applied in the medical field. It has advantages such as preoperative simulation, intraoperative positioning, intraoperative navigation, clinical teaching and so on. It plays a key role in the discovery of local anatomical variation of pulmonary segment. This paper reviewed the clinical application of three-dimensional technique and briefly described the clinical application value of this technique in segmentectomy.
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BACKGROUND@#For early-stage lung cancer, segmentectomy can get the same oncological benefits as lobectomy. Accurate identification of the intersegmental border is the key to segmentectomy. This study used extended segmentectomy and extended subsegmentectomy to treat lung intersegmental and intersubsegmental ground-glass nodules (GGN) by utilizing modified inflation-deflation methods to distinguish the intersegmental and intersubsegmental borders. The accuracy of modified inflation-deflation methods and the effectiveness of extended resection to guarantee a safe surgical margin were evaluated.@*METHODS@#A retrospective analysis of 83 cases of extended segmentectomy and extended subsegmentectomy was conducted. Preoperative three-dimensional computed tomography bronchography and angiography (3D-CTBA) revealed that nodules were involved in intersegmental or intersubsegmental veins. Based on preoperative three-dimensional reconstruction, the surgery was designed to extendedly remove the dominant lung segment or subsegment with nodules involved. When the dominant lung segment or subsegment could not be identified, the simpler lung segment or subsegment was selected for the resection. After the target vessel and bronchus were cut off during the operation, modified inflation-deflation method was used to determine the border, and a stapler was used to resect the adjacent lung segment or subsegment tissue by 2 cm-3 cm around the inflation-deflation boundary line. Then, the relationship between the inflation-deflation boundary line and the nodule and the width of the surgical margin were measured. Clinical data were collected during the perioperative period.@*RESULTS@#56 extended segmentectomies and 27 extended subsegmentectomies were performed. The average diameter of pulmonary nodules was (0.9±0.3) cm. There were 79 cases with clearly inflation-deflation boundary lines. The average time needed for the appearance of the lines was (13.6±6.5) min. In 55 cases, the nodules were involved with the inflation-deflation boundary lines. Meanwhile, the remaining 24 cases revealed an average minimum distance of (0.6±0.3) cm between nodules and the boundary lines. The average width of surgical margin was (2.1±0.3) cm in these 79 cases. No deaths or major complications appeared during 30 d after operation.@*CONCLUSIONS@#The modified inflation-deflation method can effectively define the intersegmental and intersubsegmental borders, and guarantee the safe surgical margins of extended segmentectomy and extended subsegmentectomy to treat intersegmental and intersubsegmental small lung tumors.
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Objective To explore the clinical value of three-dimensional computed tomography bronchography and angiography (3D-CTBA) in thoracoscopic dissection or combined segmentectomy.Methods The clinical data of 30 patients with isolated or multiple pulmonary nodules from September 2017 to August 2019 were retrospectively analyzed.All cases were treated with 3D-CTBA to locate the nodules accurately before operations,in order to explicit the courses of bronchi and vessels,and to observe the variations.The target bronchi,arteries and veins were resected accurately during the operations,and the intersegmental plane was determined by expansion-collapse method.Results 13 patients underwent segmentectomy and 17 patients underwent combined segmentectomy.The diameter of the nodule was (11.56 ± 3.79) mm;the depth of the nodule (the shortest distance from the visceral pleura) was (13.88 ± 3.96) mm;the operation time was (134.94 ± 18.68) min,and the intraoperative bleeding volume was (94.38 ± 37.94)ml.No cancer metastasis was found by rapid pathological examination of lymph nodes during operations.No conversion to thoracotomy.The indwelling time of thoracic tube was (3.69 ± 1.30) days,and the hospitalization days after operations was (4.81 ± 1.47)days.No serious complications or death during the perioperative period.Conclusions Preoperative 3D-CTBA has advantages in pulmonary segmentectomy,which is a safe and effective method for accurate segmentectomy.
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Objective To explore the safety and effectiveness of 3D reconstruction in thoracoscopic posterior basal segmentectomy (S10).Methods Between March 2018 to September 2018,14 patients underwent thoracoscopic anatomical resection of the posterior basal segment of the lung (S10).Results Of the 14 patients,including 5 males and 9 females,age (52.2 ± 5.3) years,size (1.1 ± 0.6) cm,6 left S10 and 8 right S10.The number of pathological type of microinvasive adenocarcinoma,benign nodule,and metastatic carcinoma was 12,1,and 1 cases.The average preoperative planning time was (44.9 ± 5.7) min,and the average operation time was (134.8 ±26.3)min.The blood loss was (25.5 ±4.1)ml,with (8.1 ± 2.7) lymphadenectomy,no positive metastasis.The coincidence rate of 3D reconstruction and intraoperative anastomosis in the tumor location,B10,A10,and V10 were 100％ (14/14),100％ (14/14),93％ (13/14) and 71％ (10/14).The median duration of chest tube insertion was (2.3 ±2.1)day.The incidence of postoperative complications was 21％ (3/14),including 7％ (1/14) of air leakage,7％ (1/14) of arrhythmia,14％ (2/14) of pulmonary infection,and 14％ (2/14) of operation.All the cutting edge was ＞ 2 cm.There was no perioperative death,no conversion to thoracotomy or lobectomy.The mean follow-up time was (8.1 ±2.2)months.There were no recurrence,metastasis or death in the 14 patients.One patient had chronic cough and no hemoptysis.Conclusions Preoperative 3D reconstruction make the anatomic thoracoscopic posterior basal segmentectomy (S10) safer and more effective.
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With the popularization of low-dose computed tomography (LDCT) scanning,the rate of the diagnosis of primary lung cancer for early-stage non-small cell lung carcinoma (NSCLC) is increasing,mainly because of a growing rate of solitary pulmonary nodule and ground-glass nodule.For these patients,recent studies have shown that segmentectomy and lobectomy have similar oncologic effects,while they can retain more lung function and improve the quality of life,so anatomical segmental resection is an alternative operation.In recent years,the three-dimensional reconstruction technology based on medical imaging has developed rapidly,which can be used to understand the anatomical structure,nodule position,spatial relationship,design of surgical path and other advantages in preoperative,and plays an important role in the thoracoscopic anatomical segmental resection with complex anatomical structure and individual differences.This paper reviews the application of three-dimensional reconstruction technology in segmental lung resection,and briefly introduces the application of this technology in precise segmental lung resection.
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Objective@#To explore the clinical value of three-dimensional computed tomography bronchography and angiography (3D-CTBA) in thoracoscopic dissection or combined segmentectomy.@*Methods@#The clinical data of 30 patients with isolated or multiple pulmonary nodules from September 2017 to August 2019 were retrospectively analyzed. All cases were treated with 3D-CTBA to locate the nodules accurately before operations, in order to explicit the courses of bronchi and vessels, and to observe the variations. The target bronchi, arteries and veins were resected accurately during the operations, and the intersegmental plane was determined by expansion-collapse method.@*Results@#13 patients underwent segmentectomy and 17 patients underwent combined segmentectomy. The diameter of the nodule was (11.56±3.79)mm; the depth of the nodule (the shortest distance from the visceral pleura) was (13.88±3.96)mm; the operation time was (134.94±18.68)min, and the intraoperative bleeding volume was (94.38±37.94)ml. No cancer metastasis was found by rapid pathological examination of lymph nodes during operations. No conversion to thoracotomy. The indwelling time of thoracic tube was (3.69±1.30)days, and the hospitalization days after operations was (4.81±1.47)days. No serious complications or death during the perioperative period.@*Conclusions@#Preoperative 3D-CTBA has advantages in pulmonary segmentectomy, which is a safe and effective method for accurate segmentectomy.
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Objective@#To explore the safety and effectiveness of 3D reconstruction in thoracoscopic posterior basal segmentectomy (S10).@*Methods@#Between March 2018 to September 2018, 14 patients underwent thoracoscopic anatomical resection of the posterior basal segment of the lung (S10).@*Results@#Of the 14 patients, including 5 males and 9 females, age (52.2±5.3)years, size (1.1±0.6)cm, 6 left S10 and 8 right S10. The number of pathological type of microinvasive adenocarcinoma, benign nodule, and metastatic carcinoma was 12, 1, and 1 cases. The average preoperative planning time was (44.9±5.7)min, and the average operation time was (134.8±26.3)min. The blood loss was (25.5±4.1)ml, with (8.1±2.7) lymphadenectomy, no positive metastasis. The coincidence rate of 3D reconstruction and intraoperative anastomosis in the tumor location, B10, A10, and V10 were 100%(14/14), 100%(14/14), 93%(13/14) and 71%(10/14). The median duration of chest tube insertion was (2.3±2.1)day. The incidence of postoperative complications was 21%(3/14), including 7%(1/14) of air leakage, 7%(1/14) of arrhythmia, 14%(2/14) of pulmonary infection, and 14%(2/14) of operation. All the cutting edge was >2 cm. There was no perioperative death, no conversion to thoracotomy or lobectomy. The mean follow-up time was (8.1±2.2)months. There were no recurrence, metastasis or death in the 14 patients. One patient had chronic cough and no hemoptysis.@*Conclusions@#Preoperative 3D reconstruction make the anatomic thoracoscopic posterior basal segmentectomy (S10) safer and more effective.
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With the popularization of low-dose computed tomography (LDCT) scanning, the rate of the diagnosis of primary lung cancer for early-stage non-small cell lung carcinoma (NSCLC) is increasing, mainly because of a growing rate of solitary pulmonary nodule and ground-glass nodule. For these patients, recent studies have shown that segmentectomy and lobectomy have similar oncologic effects, while they can retain more lung function and improve the quality of life, so anatomical segmental resection is an alternative operation. In recent years, the three-dimensional reconstruction technology based on medical imaging has developed rapidly, which can be used to understand the anatomical structure, nodule position, spatial relationship, design of surgical path and other advantages in preoperative, and plays an important role in the thoracoscopic anatomical segmental resection with complex anatomical structure and individual differences. This paper reviews the application of three-dimensional reconstruction technology in segmental lung resection, and briefly introduces the application of this technology in precise segmental lung resection.
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@#Thoracoscopic pulmonary segmentectomy is one of the important treatment methods for early lung cancer. Only the premise of surgical precision can make the radical resection of lesions and maximum reservation of healthy lung tissue be simultaneously guaranteed. As a representative of the precise lung operation, the “cone-shaped lung segmentectomy” focuses on the lesion, and combines the anatomical characteristic of the patient to design individualized operation scheme. The technological core consists of three parts, three dimensional-computed tomography bronchography and angiography (3D-CTBA) surgery path planning, accurate definition of intersegmental demarcation and anatomic dissection of intersegmental borders along the demarcation. This paper aims to explore the technical process and quality control of the key techniques of thoracoscopic precise segmentectomy, so as to standardize the segmentectomy procedure under the principle of radical and minimally invasive therapy.
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We report here on a case of sand aspiration in a 32-year-old man who had been accidentally buried in the deep pile of sand for four hours. Chest radiograph showed bilateral fluffy consolidations and nodular lesions with a typical 'sand bronchogram' in both lower lung zones, and these findings were more clearly visualized on the HRCT. The patient recovered completely with conservative treatment that included mechanical ventilation and postural drainage.
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Adult , Humans , Bronchography , Drainage, Postural , Lung , Radiography, Thoracic , Respiration, Artificial , Silicon DioxideABSTRACT
PURPOSE: To determine which contrast media are both efficient and safe for the imaging of airways. MATERIALS AND METHODS: We evaluated five contrast media (barium, gastrografin, iotrolan, ioxaglate, iopentol) in terms of image quality and their effects on the lungs of 25 white rabbits. For bronchography 0.5ml of contrast media was used. In each contrast group, HRCT scans were obtained immediately (n=5), 12 hours (n=4), 1 day (n=3), 2 days (n=2), and 1 week (n=1) after bronchography. Histopathologic specimens were obtained immediately, 12 hours, 1 day, 2 days, and 1 week later. Bronchograms were evaluated for image quality by three radiologists working independently, and were scored as 1(poor), 2(moderate), or 3(good) in terms of contrast quality and bronchial coating. HRCT was evaluated by two radiologists who reached a concensus; they determined the presence of contrast media, and then the pattern and extent of pulmonary opacity, and any related changes. Histopatholgic specimens were evaluated by two pathologists who sought consensus as to the extent of inflammation, pulmonary edema, and hemorrhage, and any changes in these aspects. RESULTS: Bronchography indicated that the sum of scores for contrast quality was 45 for barium, 33 for gastrografin, 28 for iotrolan, 30 for ioxaglate, and 28 for iopentol, while for each of these media, the sum of scores for bronchial coating was 39, 19, 25, 23, and 21, respectively. Barium showed the best image quality. In all rabbits, HRCT demonstrated the variable extent of groundglass attenuation and/or consolidation. Lesions were most extensive at 1-2 days and then regressed at 1 week; these HRCT findings correlated well with histologic findings. In histologic studies of all five contrast media groups, variable severe inflammatory reactions were observed, with or without necrosis, congestion, edema, and hemorrhage. It was noted that ioxaglate appeared to cause least tissue reaction. CONCLUSIONS: The imaging results of this experimental study indicate that for bronchography, barium is the best available contrast media, On the basis of the histologic and HRCT results, however, ioxaglate is the best.