Three-dimensional Reconstruction Technique Was Used To Simulate The Major Anatomical Structures Of The Lungs And Guide Segmentectomy

ObjectiveThe anatomical structure of the lung is complex and variable,and the field of vision under thoracoscopy is limited,resulting in high difficulty of thoracoscopic lung surgery.In order to simulate the anatomical characteristics of the pulmonary,in this study,Mimics 21.0 software was used for three-dimensional reconstruction of the pulmonary artery、vein、bronchus and statistical analysis the variation of the pulmonary.And investigating the application of three-dimensional reconstruction in thoracoscopic segmentectomy,in order to provide reliable and detailed preoperative auxiliary data for lung surgery.Methods1.A total of 295 patients treated for pulmonary nodules by our treatment group in the First Affiliated Thoracic Surgery Department of Zhengzhou University from August 2020 to August 2021,their CT data were selected for three-dimensional reconstruction of pulmonary vessels,bronchi,nodules and lung tissues,and the anatomical structure of pulmonary artery、vein、bronchus was analyzed statistically.2.A retrospective analysis was performed on who underwent thoracoscopic segmentectomy for pulmonary nodules in the First Affiliated Hospital of Zhengzhou University by our treatment group from January 2021 to November 2021,including 30 patients underwent preoperative three-dimensional reconstruction and 30 patients without three-dimensional reconstruction.The operation duration,intraoperative blood loss,postoperative drainage volume,drainage tube removal time,postoperative hospital stay and perioperative complications were collected for statistical analysis.Results1.In this study,there are 31 anatomical types of the upper lobe of the right lung,the number of right upper lobe arteries is 1 to 4,2 stems is the most common type(N=175,59.3%),followed by 3 stems type(N=77,26.1%),1 stem type(N=28,9.5%),4 stems type(15 cases,5.1%),2 cases(0.7%)were found in the common trunk of anterior segmental artery or it’s subsegmental artery and right middle pulmonary artery,and 21 cases(7.1%)were found in posterior segmental artery or it’s subsegmental artery and superior segmental artery.The number of right middle arteries is 1 to 3,2 stems is the most common type(N=185,62.7%),followed by 1 stem type(N=97,32.9%)and 3 stems type(N=13,4.4%),7 cases(2.4%)were found in the common trunk of basal pulmonary artery.The number of branches of dorsal segment of the lower lobe of the right lung is 1 to 3,with 1 stem is the most common type(N=243,82.4%),followed by 2 stems type(N=49,16.6%)and 3 stems type(N=3,1.0%),and 8 cases(2.7%)were found in the common trunk of basal pulmonary artery.There are 20 anatomical types in the basal segment of the lower lobe of the right lung,the basal segment arteries of the right lower lobe is 2 to 4 stems,3 stems is the most common type(N=171,58.0%),followed by 2 stems type(N=113,38.3%)and 4 stems type(N=11,3.7%).2.The anatomical structure of the left upper lobe artery is extremely complex and variable.A total of 53 anatomical types were found,and the number of arteries ranged from 2 to 7,4 stems is the most common type(N=127,43.1%),followed by 3 stems(N=78,26.4%),5 stems(N=68,23.1%),6 stems(N=14,4.7%),and 2 stems(N=6,2.0%)and 7 stems(N=2,0.7%).In this study,57 cases(19.3%)were found to have Mediastinal lingular artery,and 50 cases(16.9%)were found in common trunk of lingular artery and basal pulmonary artery,2 cases(0.7%)were found in common trunk of apicoposterior segment artery and dorsal segment artery.The number of left lower lobe dorsal segment arteries ranged from 1 to 3,with 1 stem is the most common type(N=221,74.9%),followed by 2 stems(N=65,22.0%)and 3 stems(N=9,3.1%).6 cases(2.0%)were found in common trunk of dorsal segment artery or it’s subsegment and the basal segment artery.The anatomical structure of the basal segment artery of the lower lobe of the left lung was relatively stable with less variation.A total of 11 anatomical types were found,with 2-3 arteries,2 stems is the most common type(N=272,92.2%),followed by 3 stems(N=23,7.8%).3.A total of 58 cases(19.7%)of right pulmonary vein variation and were found in this study,with 9 abnormal anatomical types.The most common venous variation of right lung was 3 pulmonary veins flowing into the heart(N=46,15.6%).A total of 44 cases(14.9%)of left pulmonary vein variation were found in this study,with 4 abnormal anatomical types.The most common anatomic variation of left lung is left pulmonary vein merging into one branch before entering the heart(11.5,N=34)at the left side lung.4.A total of 11 anatomical types were found in the right upper lobe bronchus,and the number of bifurcation ranged from 2 to 4.3 bifurcation is the most common type with 2 anatomical types(N=187,63.4%).Followed by 2 bifurcation with 5 anatomical types(N=99,33.6%).4 bifurcation with 2 anatomical types(N=7,2.4%).Two special anatomical types were found,B2 and B1+B3 respectively originated from the right main trachea in 1 case(0.3%).B1 and B2+B3 respectively originated from the right main trachea in 1 case(0.3%).The anatomical structure of the right middle lobe bronchus was relatively fixed,and 3 anatomical types were found.The number of right lower lobe dorsal bronchus is 1 to 2,and 1 dorsal bronchus is the most common in 289 cases(98.0%).The variation of the basal segment bronchus of the right lower lobe was less,and 4 anatomical types were found.5.A total of 4 anatomical types were found in the left upper lobe apical、posterior and anterior bronchus,2 bifurcation is the most common type(N=252,85.4%),followed by 3 bifurcation(N=43,14.6%).The anatomical structure of the lingual bronchus of the left lung is relatively fixed,and there are 3 anatomical types.A special anatomical type was found in the upper lobe,the lingual segmental bronchus originated from the anterior segmental bronchus in 2 cases(0.7).The bronchus of left lower lobe dorsal segment is all one branch,and no other branches were found.The anatomical structure of the basal segment of the lower lobe of the left lung is relatively fixed,and 4 anatomical types were found.6.There was no significant difference in the basic information(gender,age,smoking history,lung function,lung segment resection scope)between the two groups(p>0.05).The operation time of the three-dimensional reconstruction group(131.07±27.15)min was shorter than the control group(152.43±35.10)min,and the intraoperative blood loss of the three-dimensional reconstruction group 50.00(30.00,50.00)ml was less than the control group 55.00(50.00,72.50)ml,the difference was statistically significant(P<0.05).There were no significant differences in postoperative drainage volume,drainage tube removal time,postoperative hospital stay and perioperative complications between 2 groups(P>0.05).Conclusion1.The anatomy of pulmonary arteries,veins and bronchi is complex and variable.Surgeons can accurately grasp the anatomical characteristics of each patient’s lungs by three-dimensional reconstruction before operation.2.Three-dimensional reconstruction technology can help reduce the operation time of surgery and intraoperative blood loss,assist doctors to make accurate and individualized surgical plan,and make the operation more safe and fast.