解剖学报

解剖学报 ›› 2022, Vol. 53 ›› Issue (2): 217-224.doi: 10.16098/j.issn.0529-1356.2022.02.012

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肺内血管的影像解剖学在肺段切除术的临床应用

张银萍1 吴菲1 余慧1 唐瑶1 张慧2* 陈伟3   

  1. 1.长沙医学院医学影像学院， 长沙410219; 2.长沙医学院人体解剖学教研室， 长沙 410219; 3.中南大学湘雅医院放射科， 长沙 410008
  • 收稿日期:2021-02-24 修回日期:2021-03-29 出版日期:2022-04-06 发布日期:2022-04-06
  • 通讯作者: 张慧 E-mail:HuiZhang0601@126.com
  • 基金资助:
    2019年湖南省大学生创新创业训练计划项目;湖南省普通高等学校课程思政建设研究项目

Clinical application of imaging anatomy of pulmonary vessels in segmental pulmonary resection

ZHANG Yin-ping1  WU Fei1  YU Hui1  TANG Yao1  ZHANG Hui2*  CHEN Wei3   

  1. 1.School of Medical Imaging， Changsha Medical College， Changsha 410219, China; 2.Department of Human Anatomy，Changsha Medical College， Changsha 410219, China;  3.Department of Radiology,Xiangya Hospital，Central South University，Changsha 410008，China
  • Received:2021-02-24 Revised:2021-03-29 Online:2022-04-06 Published:2022-04-06
  • Contact: ZHANG Hui E-mail:HuiZhang0601@126.com

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摘要：

目的 对肺内血管予以三维重建后探讨其解剖结构的走形变异对肺段切除术术式的影响，为临床肺段切除术提供影像解剖学基础。  方法 随机抽取中南大学湘雅医院2019～2020年100例肺部增强CT未见明显异常的成年人样本，分别予以三维重建后进行肺血管主干及分支走行的全方位观察。  结果 左肺动脉主干变异率为1%；尖后段、前段动脉变异率为18%，舌段动脉变异率为10%，背段动脉无变异，基底段动脉变异率为1%。右肺动脉主干变异率为1%，尖后段、前段动脉变异率为17%，舌段动脉变异率为22%，背段动脉无变异，基底段动脉变异率为13%。左肺静脉主干变异率为3%，尖后段、前段静脉变异率为20%，舌段静脉变异率为16%，背段静脉变异率1%，基底段静脉变异率为19%；右肺静脉主干无变异，尖后段、前段静脉变异率为25%，内侧段、外侧段静脉变异率为16%，背段静脉变异率1%，基底段静脉变异率为28%。  结论 肺内血管解剖结构复杂多样，尤以尖后段与前段、各基底段的组合较为多样化，内侧段与外侧段不符解剖位置关系，背段走形较为固定。影像三维重建技术能准确清晰地反映肺内血管走行，为临床影像学定位诊断及肺段切除术前评估血管解剖提供了影像学资料。

关键词: 肺动脉, 肺静脉, 肺癌, 三维重建, 肺段切除术, 人

Abstract:

Objective To explore the effect of variation of the anatomical structure on the surgical method  of segmentectomy, after the three-dimensional(3D) reconstruction of the pulmonary vessels,which provide the basis of imaging anatomy for clinical segmentectomy.   Methods A total of 100 adult lung samples with no obvious abnormalities in enhanced CT were randomly selected from Xiangya Hospital of Central South University from 2019 to 2020, respectively, and three-dimensional reconstruction was performed for all-round observation of the main and branch routes of pulmonary vessels. Results The variation rate of left main pulmonary artery was 1%, the variation rate of posterior apex and anterior segment artery was 18%, the variation rate of lingual segment artery was 10%, the variation rate of dorsal segment artery was no variation, and the variation rate of basilar segment artery was 1%. The variation rate of right main pulmonary artery was 1%, the variation rate of posterior apex and anterior segment artery was 17%, the variation rate of lingual segment artery was 22%, the variation rate of dorsal segment artery was no variation, and the variation rate of basilar segment artery was 13%. The variation rate of main left pulmonary vein was 3%,the variation rate of the posterior apical and anterior segment vein was 20%, the variation rate of the lingual segment vein was 16%,the variation rate of the dorsal segment vein was 1%, and the variation rate of the basal segment vein was 19%. There was not variation in the main vein of the right lung, and the variation rate of posterior apical and anterior segments vein was 25%, the variation rate of medial and lateral segments vein was 16%, the variation rate of dorsal segment vein was 1%, and the variation rate of basal segment vein was 28%.  Conclusion The anatomical structure of the pulmonary system is complex and diverse, especially the combination of the apical-posterior segment, the anterior segment and the basal segment, the posterior segment has commonly a fixed anatomical course,the medial segment and the lateral segment are different with traditional anatomical position relation. The 3D reconstruction technique can accurately and clearly reflect the course of pulmonary vessels and summarize their variation types, providing imaging data for clinical imaging location diagnosis and evaluation of vascular anatomy before pulmonary segmentectomy.

Key words: Pulmonary artery, Pulmonary vein, Lung cancer, Three-dimensional reconstruction, Pulmonary segmentectomy, Human

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