Department of Thoracic Surgery,The First Affiliated Hospital of Nanjing Medical University
Six talent peaks project in Jiangsu Province
目的：本研究探讨S2b+S3a联合亚段切除术治疗位于右上肺前段(S2)和后段(S3)之间早期非小细胞肺癌等肺结节的可行性与安全性。方法：回顾本中心2015-2020年肺段切除术资料,在术前三维CT支气管血管成像(Three-dimensional computed tomography bronchography and angiography,3D-CTBA)规划及术中3D-CTBA实时导航下,以段间静脉V2c为辨认标志确定S2与S3之间的结节,将S2的外侧亚段(S2b)和S3的外侧亚段(S3a)合并为一个切除单元,分析接受S2b+S3a联合亚段切除术的患者结节特征及围术期资料。结果：共纳入46例S2b+S3a切除术病例,结节影像学大小为11.57±3.65 mm。根据结节实性成分占比(Consolidation to tumor ratio, CTR),纯磨玻璃结节29例,部分磨玻璃结节11例,实性为主结节3例,实性结节3例。 有35例结节位于肺实质外1/3,11例位于肺实质中1/3,无内1/3结节。结节病理大小为9.48±3.06 mm,病理诊断如下：AIS(8例),MIA(19例),IAC(15例),良性(3例),转移瘤(1例)。平均淋巴结采样站数为2.57±1.42 ,采样总数为4.50±3.06。平均切缘为18.21± 3.24 mm,术后住院时长中位数4天,带管时间中位数2天,出现长期漏气(≥3天)2例及术后咯血2例,无围术期死亡,随访终点无术后复发及死亡。结论：在3D-CTBA的合理规划下,S2b+S3a联合亚段切除术是治疗右上肺S2和后S3之间早期非小细胞肺癌等肺结节的一种安全可行的方式。
Objective: We aimed to explore the feasibility and safety of S2b+S3a combined subsegmentectomy for pulmonary nodules between S2 and S3 in the right upper lung. Methods: We retrospectively analyzed the clinical data of segmentectomy in our center from 2015 to 2020. Under the preoperative three-dimensional computed tomography bronchography and angiography (3D-CTBA) planning and the real-time navigation of 3D-CTBA intraoperatively, the nodule between S2 and S3 was identified using intersegmental vein V2c, and the lateral subsegment of S2 (S2b) and the lateral subsegment of S3 (S3a) were combined as a new resection unit. We further analyzed the nodule characteristics and perioperative data of S2b+S3a resection. Results: A total of 46 cases of S2b+S3a resection were included. The size of nodules in the CT image was 11.57±3.65 mm. The pathological diameter was 9.48±3.06 mm. According to the consolidation to tumor ratio (CTR), the nodules were classified as: pure-GGO (Ground Glass Opacity, GGO) nodules (30 cases), partial-GGO nodules (11 cases), partial-solid nodules (3 cases), and pure-solid nodules (3 cases). There were 35 nodules located in the outside 1/3 of lung parenchyma and 11 nodules located in the middle 1/3 of lung parenchyma. The pathological diagnosis included: adenocarcinoma in situ (AIS, 8 cases), minimally invasive adenocarcinoma (MIA, 19 cases), invasive adenocarcinoma (IAC, 15 cases), benign (3 cases), and metastatic tumor (1 case). The number of lymph node sampling stations was 2.57±1.42 and resected lymph nodes was 4.50±3.06. The mean surgical margin was 18.21± 3.24 mm. The median postoperative hospital stay was 4 days, and the median chest tube drainage time was 2 days. Long-term air leakage (≥3 days) and postoperative hemoptysis occurred on 2 patients respectively. No perioperative death, postoperative recurrence, or postoperative death happened at the follow-up endpoint. Conclusion: S2b+S3a combined subsegmentectomy is a safe and feasible method to manage pulmonary nodules such as early non-small cell lung cancer (NSCLC) between S2 and S3 under the navigation of 3D-CTBA.