Clinical Study On The Application Of 3D Reconstruction In Lung Anatomy And Operation

Background:In recent years,minimally invasive techniques in lung surgery have been developed rapidly and popularized worldwide.Coupled with the increase in the detection rate of pulmonary nodules,minimally invasive surgery has become the first choice for the treatment of early-stage lung tumors.Segmentectomy is more complicated than standard lobectomy because segmental bronchial and vascular structures can change individually at different levels.Therefore,it is particularly important to know the types of pulmonary bronchopulmonary vessels and rare anatomical variations before operation for safe and accurate lung surgery.In order to reduce the possible risks during surgery,improve the safety of surgery,and achieve accurate resection,three-dimensional(3D)visualization technology emerged and flourished.Mimics software allows segmentation of the anatomy to create accurate three-dimensional(3D)images.The digital technology is widely used in stomatology,orthopedics,etc.,and is increasingly used in thoracic surgery,but there is still a lack of clinical application research of big data.In thoracic surgery,3D visualization technology takes chest CT as the original data,and the 3D imaging established by computer post-processing can be used for data analysis and simulation.Through corresponding operations,the adjacent relationship between bronchi and blood vessels in the operation area can be shown by fluoroscopy,which is conducive to surgical treatment.The purpose of this study is to analyze the anatomical structure of pulmonary bronchi and blood vessels by three-dimensional reconstruction,and to explore the application of three-dimensional reconstruction in the surgery of patients with pulmonary anatomical variation,so as to provide surgical guidance for clinicians.Objective:To explore the characteristics of lung anatomy and the clinical value of preoperative three-dimensional reconstruction in reducing the surgical risk of patients with pulmonary anatomical variation.Methods:This study retrospectively analyzed the data of 380 patients who underwent lung cancer surgery(lobectomy,segmentectomy,and pulmonary wedge resection)at the Department of Thoracic Surgery,Zhujiang Hospital,Southern Medical University from August 2020 to October 2022.Three-dimensional images were obtained by using MIMICS software.A total of 110 patients with anomalous bronchi or vessels were identified by analyzing the three-dimensional reconstruction of the lung.According to the presence or absence of preoperative three-dimensional reconstruction images,110 patients were divided into reconstruction group(59 cases,53.6%)and non-reconstruction group(51 cases,46.4%).The primary outcome was the operation time,intraoperative blood loss,postoperative drainage volume,and the secondary outcome included postoperative complications.The characteristics of bronchial and vascular of all patients were analyzed.Results:1.59 patients(53.6%)in the reconstruction group had significantly shorter operative time than 51 patients(46.4%)in the non-reconstruction group(137.03±27.69 vs.171.67±19.15 minutes,P<0.001)and reduced intraoperative blood loss(58.56±33.56 vs.112.25±55.54 ml,P<0.001).2.This study found six cases of four branches of the right upper lung bronchus,one case of the anterior segment bronchus and the middle lobe bronchus,five cases of the posterior segment bronchus originating from the right main bronchus,one case of left pulmonary double artery variation,and four cases of mediastinal lingual artery.Superior main trunk+ascending artery is the most common type of right superior pulmonary artery.The type of right superior pulmonary vein is anterior+central vein,and single anterior vein or central vein is rare.Conclusions:Preoperative planning with three-dimensional imaging can shorten the operation time and reduce intraoperative bleeding in operations with anatomical variation,and can find the anatomical variation of the lung before operation,reduce the damage of the trachea and blood vessels during operation,and improve the success rate of operation.