ObjectiveTo determine the intersegmental plane of lung by thoracoscopic pulmonary segmental resection with inflatio-deflation method, and investigate the clinical effects of cutting out the three-dimensional intersegmental plane after dimensionality reduction.
MethodsThe clinical data of 28 patients treated with minimally invasive thoracoscopic pulmonary segmentectomy by the dimensionality reduction handling intersegmental plane from December 2018 to December 2019 were retrospectively analyzed.The lung lesions in all patients were identified uisng the thin-layer CT of chest before operation, the pulmonary segmentectomy was implemented under the guidance of three-dimensional reconstruction of thoracoscopy, and some patients with multiple nodules were treated with pulmonary wedge resection additionally.After the pulmonary artery, vein and trachea were treated, the intersegment junction was shown by the inflation-deflation method, the three-dimensional intersegmental plane was separated by ultrasonic knife or electric hook and other energy instruments to reduce the three-dimensional dimension of the intersegmental plane.The intersegmental vein was used as an important intersegmental plane symbol to guide the reduction of the dimension, and the intersegmental plane after the dimensionality reduction was processed by cutting stapler.
ResultsThe operation was successfully completed in all groups, and no cases were transferred to thoracotomy.Thoracoscopic anatomy was clear, and the operation was smooth.Nine patients were treated with single pulmonary segmentectomy, 11 patients were treated with pulmonary segmentectomy combined with pulmonary segmentectomy or subpulmonary segmentectomy, and 8 patients were treated with pulmonary segmentectomy combined with pulmonary wedge resection.A total of 37 lesions were resected.The boundary between sections was clearly visible for about 15 minutes after the inflation-deflation.There was no obvious bleeding in the plane of the separation segment with ultrasonic scalpel or electric hook, and the veins between segments were retained.The lung was expanded after the operation, with good lung stretch and no severe pressing.After operation, 5 cases with mild pulmonary air leakage were healed by drainage, and the pulmonary reexamination showed good lung expansion.The total drainage volume was (494.64±332.45)mL, the drainage time was (4.04±1.50)d, and the length of hospital stay was (6.79±2.46)d.There were no serious complications and death in perioperative period.
ConclusionsThe pulmonary segmentectomy can be safely operated under the minimally invasive thoracoscopy, the inflation-deflation method can clearly show the intersegmental plane of lung, the three-dimensional intersegmental plane can be easier to cut after dimensionality reduction, relieve squeezing and achieve better stretch of the rest lungs.
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