刘海涛 王黎彬 戚维波 杨帆 施谷平 张小航 赵俊杰 马兴杰

[摘要] 目的 探討利用Deepinsinght软件进行三维重建及虚拟手术规划在胸腔镜解剖性肺段切除术中的应用价值。方法 回顾性分析2018年1～12月我院行胸腔镜解剖性肺段切除术治疗的22例术前疑似早期肺癌患者的临床资料。术前将胸部增强CT检查的断层二维图像信息以DICOM格式导入Deepinsinght系统中进行三维重建及虚拟手术规划实施精准肺段切除。观察指标：①术前三维重建及虚拟手术规划情况;②术中及术后情况。③随访情况。 结果 ①术前三维重建及虚拟手术规划情况：22例患者术前均完成三维重建和虚拟手术规划;②术中及术后情况：22例患者均顺利行胸腔镜解剖性肺段切除术，无中转开胸。22例患者手术时间为（115.05±27.54）min，术中出血量为（78.64±16.14）mL，术后拔管时间为（3.55±1.06）d，术后住院时间为（7.27±2.62）d。术后发生肺部感染2例，发生肺动脉栓塞1例，均经保守治疗后痊愈。术后肿瘤TNM分期为：良性肿瘤1例，0期9例，IA期11例、IB期2例。三维重建和虚拟手术规划评估肿瘤性质的准确率为95.5%（21/22）。③随访情况：随访期间所有患者均未发生局部复发、远处转移及死亡情况。 结论 应用三维重建及虚拟手术规划能实现精准肺段切除，可提高胸腔镜解剖性肺段切除术的准确性和安全性。

[关键词] 肺部肿瘤;三维重建技术;虚拟手术规划技术;肺段切除术

[中图分类号] R655.3          [文献标识码] A          [文章编号] 1673-9701（2020）32-0004-04

[Abstract] Objective To explore the application value of three-dimensional reconstruction and virtual surgical planning using Deepinsinght software in thoracoscopic anatomic lung segment resection. Methods The clinical data of 22 patients with preoperative suspected early lung cancer who underwent thoracoscopic anatomic lung segment resection in our hospital from January to December 2018 were retrospectively analyzed. The two-dimensional tomography information of chest enhanced CT examination was imported into Deepinsinght system in DICOM format for 3D reconstruction and virtual surgical planning for accurate lung segment resection. The observation index included： ①preoperative three-dimensional reconstruction and virtual operation planning; ②intraoperative and postoperative conditions; ③follow-up situation. Results ①Preoperative three-dimensional reconstruction and virtual operation planning： All the 22 patients completed 3D reconstruction and virtual operation planning before the operation. ②Intraoperative and postoperative conditions： All the 22 patients underwent thoracoscopic anatomic lung segment resection successfully， without conversion to thoracotomy. The operative time of 22 patients was（115.05±27.54）min， the intraoperative blood loss was（78.64±16.14）mL， the postoperative extubation time was（3.55±1.06）d， and the postoperative hospital stay was（7.27±2.62）d. Postoperative pulmonary infection occurred in 2 cases and pulmonary embolism in 1 case， all of which were cured after conservative treatment. Postoperative tumor TNM stage was benign in 1 case， stage 0 in 9 cases， stage IA in 11 cases， and stage IB in 2 cases. The accuracy of 3D reconstruction and virtual surgical planning in assessing the nature of the tumor was 95.5%（21/22）.③Follow-up：No local recurrence， distant metastasis， or death occurred during the follow-up period. Conclusion The application of 3D reconstruction and virtual surgical planning can achieve accurate lung segment resection and improve the accuracy and safety of thoracoscopic anatomic lung segment resection.

[Key words] Lung tumor; Three-dimensional reconstruction technology; Virtual surgical planning technology; Lung segment resection

近年来，肺癌的死亡率逐年上升，已居恶性肿瘤死亡之首[1-2]。随着低剂量螺旋CT广泛地应用于普查，早期肺癌越来越多地被发现。……