Objective To study the anatomy and drainage pattern of pulmonary veins in the lower lobes of both lungs in healthy people by using multi-slice spiral CT (MSCT), and to elucidate its characteristics, so as to provide basis for the anatomical classification of target veins in anatomic segmental pneumonectomy. Methods The CT image data of 200 cases with normal lung were collected, and the venous anatomy and drainage pattern were obtained by VR reconstruction. The occurrence rate of venous classification was observed and counted. Combined with the reconstructed 5 mm axial MIP map, three key observation planes were selected to identify the corresponding subtypes. Results V6 could be divided into two types according to the number of stems: single trunk (88%), which was the most common type, and double trunk (12%). In addition, there was an independent segment S* between S6 and S10. There were independent segmental bronchi (B) and arteries (A). The bilateral inferior pulmonary basal veins were characterized by radial arrangement. Most of the branches of the medial basal segment vein (V7) were thin in diameter. The branching patterns of anterior basal segment, lateral basal segment and posterior basal segment veins (V8, V9, V10) could be divided into the following four types: V8+V9 / V10 type, V8 / V9+V10 type, V8+V9+V10 / V10 type, and V8+V9 / V9+V10 type, with different proportion in each type. Conclusions The anatomical classification and drainage pattern of pulmonary veins can be used as a routine means of anatomical recognition, which provides basis for the fine anatomical evaluation of pulmonary veins before segmentectomy. The data obtained in this study can be used as a supplement to 3D-CT images, which can help to understand the fine anatomy of target veins and bronchi after segmentectomy.
Key words
Lower lobe of both lungs /
/
/
Venous drainage /
/
/
Bronchial tube /
/
/
Multi slice spiral CT /
Anatomical segmentectomy
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 野守裕明, 冈田守人编著, 葛棣等译. 肺癌解剖性肺段切除图谱[M]. 天津：天津科技翻译出版有限公司, 2017.1. ISBN：9787543336407.
[2] 张家豪, 张亚杰, 李鹤成. 早期肺癌肺段切除：从技术到临床研究[J].中国胸心血管外科临床杂志, 2020, 27(10): 1127-1133. DOI:10.7507/1007-4848.201912016.
[3] Ghaly G, Kamel M, Nasar A, et al.Video-Assisted thoracoscopic surgery is a safe and elective alternative to thoracotomy for anatomical segmentectomy in patients with clinical stage I non-small cell lung cancer[J]. Ann Thorac Surg, 2016, 101(2):465-472. DOI:10.1016/j.athoracsur.2015.06.112.
[4] Rocco G, Internullo E, Cassivi SD, et al. The variability of practice in minimally invasivethoracic surgery for pulmonary resections[J]. Thorac Sur Clin, 2008, 18(3): 235-247. DOI:10.1016/j.thorsurg.2008.06.002.
[5] Okada M, Sakamoto T, Yuki T, et al. Hybrid surgical approach of video-assisted minithoracotomy for lung cancer: significance of direct visualization on quality of surgery[J]. Chest, 2005, 128(4): 2696-2701. DOI: 10.1378/chest.128.4.2696.
[6] Nagashima T, Shimizu K, Ohtaki Y, et al. Analysis of variation in bronchovascular pattern of the right middle and lower lobes of the lung using three-dimensional CT angiography and bronchography [J] . Gen Thorac Cardiovasc Surg, 2017, 65(6), 343-349. DOI: 10.1007/s11748-017-0754-4.
[7] Wolf AS, Richards WG, Jaklitsch MT, et al. Lobectomy versus sublobar resection for small(2 cm or less) non-small cell lung cancers[J]. Ann Thorac Surg,2011,92(5):1819-1823. DOI: 10.1016/j.athoracsur. 2011. 06.099.
[8] Yim AP. VATS major pulmonary resection revisited-controversies, techniques, and results[J]. Ann Thorac Surg, 2002, 74(2):615-623. DOI: 10.1016/s0003-4975(02)03579-8.
[9] Lex JR, Naidu B. In patients with resectable non-small-cell lung cancer, is video-assisted thoracoscopic segmentectomy an appropriate alternative to video-assisted thoracoscopic lobectomy[J]. Interact Cardiovasc Thorac Surg, 2016, 23(5):826-831.DOI:10.1093/icvts/ivw202.
[10] Martin-Ucar AE, Nakas A, Pilling JE, et al. A case-matched study of anatomical segmentectomy versus lobectomy for stage I lung cancer in high-risk patients[J]. Eur J Cardiothorac Surg, 2005,27:675-679. DOI: 10.1016/j.ejcts.2005.01.006.
[11]Rizk NP, Ghanie A, Hsu M, et al. A prospective trial comparing pain and quality of life measures after anatomic lung resection using thoracoscopy or thoracotomy[J]. Ann Thorac Surg, 2014, 98(4):1160-1166. DOI: 10.1016/j.athoracsur.2014.05.028.
PDF(5047 KB)
