Morphological Analysis Of The Vessels And Bronchus Of The Left Lobe Based On IQQA-3D Three-dimensional

Objective:To analyze the three-dimensional anatomical pattern of the left lobe,and to analyze the morphological variation types of common and rare bronchial and vascular branches.Methods:First affiliated hospital of fujian medical university were retrospectively analyzed in thoracic surgery between January 2019 and March 2021,100 cases of quasi anatomical sex lung segment resection of lung nodules in patients with preoperative lung CT image data application of 3 d reconstruction software（IQQA–3D）lung anatomy simulation reconstruction,and the model is used to the left side lobe bronchus after reconstruction with vascular branch form statistics and analysis,and compared with previous research data.Results:Left upper lobe:the bronchial branching pattern of the left upper lobe was mainly two-branched（98%）,and B³ moved down in 2 patients to form a rare variant of three-branched type.The second opening of the proper segment bronchus and the second opening of the lingual segment bronchus were the most common（63%）.Three and four branches of the left upper lobe artery were the most（81%）,and the first branch of the left pulmonary artery was mostly distributed in the anterior segment or the anterior segment and the posterior apex segment.A¹⁺²a+A³,A¹⁺²b,A¹⁺²c（41%）and A¹⁺²（a+b）+A³,A¹⁺²c（35%）were the most common arterial branches in the left upper proper segment of the lung.The branches of lingual artery are relatively fixed,but the origin is complex.20%of the lingual artery branches originate from the basilar trunk.Boyden I type was the most common vein in the posterior segment of the apex（54%）.Most of the branches of V³were directly into the left superior pulmonary vein（54%）.The superior lingual vein（V⁴）and inferior lingual vein（V⁵）mostly confluence into the lingual vein trunk（87%）.In 3%of patients,the inferior lingual vein did not confluence into the left superior pulmonary vein but into the basilar vein trunk of the left inferior pulmonary vein.Left lower lobe:almost all B⁶ originates from the single stem（99%）,but only 1%from the double stem.B⁶a,B⁶b+c are the most common branching types of B⁶（47%）.The basal trunk bronchus was common in two branches（74%）.B⁸,B⁹⁺¹⁰ are the most common branching types of basal trunk bronchi.Absence of B⁹b was observed in 3 patients,and inferior dorsal segmental bronchi（B*）was observed in 25 patients,originating between B⁸ and B⁹⁺¹⁰in21%,and between B⁶ and B⁸ in 4%.The most common branch of the dorsal segment（A⁶）was a single branch（71%）.A⁸ and A⁹⁺¹⁰ were the most common branches of the basilar trunk（49%）,and in 30 patients,the branches of lingual segment artery merged with the basilar trunk.The lower dorsal segment bronchus（B*）with A*was observed in 25%of all patients.V⁶b was absent in 21%of patients.V⁸,V⁹⁺¹⁰ were the most common branches of the basilar vein（45%）.A branch of lingual vein was also observed to drain into the trunk of the basal vein in 3 patients.Conclusion:The vascular and bronchial structures of the left lobe are complex,and there are many morphological variations of the branches.The surgical surgeons should fully grasp the anatomical structure of the pulmonary segments in the surgical area before operation.This study has certain reference value for carrying out the left anatomical pulmonary segmental resection.