单孔胸腔镜复杂联合RS9+10bii亚段切除术：双显示法与联合方法（裂缝穿透和韧带穿透）

Uniportal Thoracoscopic Complex Combined Seg-Sub-subsegmentectomy of RS9+10bii: Dual-Display Method and Combined Approaches (Trans-fissure and Trans-ligament)

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ANNALS OF SURGICAL ONCOLOGY

影响因子:3.5

分区:医学2区 / 外科2区肿瘤学3区

发表日期:2024 Nov

作者: Junhao Wu, Chuan Li, Chengwu Liu

DOI: 10.1245/s10434-024-15860-2

摘要

单孔胸腔镜侧基底段切除术是最具技术挑战的解剖学分段切除术之一，尤其是在涉及联合亚段切除或亚亚段切除时。因此，关于其技术方面的报道极少。在本文多媒体资料中，我们描述了一种通过斜裂缝途径和肺韧带下缘途径实现的极其复杂的RS9+10bii联合seg-sub-subsegmentectomy，遵循单向策略，利用stem-branch法进行分段/亚段/亚亚段结构追踪，并采用包括静脉注射ICG法和充放气法的双显示法，以识别节段间和节段-亚段-亚亚段平面。手术耗时169分钟，出血约20毫升。术后第1、4和19天，患者出现活动性血胸和两次自发性气胸，均在治疗后迅速恢复。标本的组织病理学检查证实侵袭性非粘液腺癌，边缘阴性，淋巴结未转移。分期为pT1bN0M0，IA2期。在随访的14个月内未观察到肿瘤复发或转移。术后第6个月，FVC、FEV1及FEV1%的下降分别为11.9%、12.5%和12.8%。复杂的基底段切除术需联合亚段或亚亚段切除（如RS9+10bii），可通过双显示法和联合技术实现。这一方法简化了极其复杂的联合亚段切除步骤，避免了大范围肺切除。此外，在进行这些联合分段时，精确的解剖解剖剥离对于预防诸如轻微支气管胸壁瘘等并发症至关重要。

Abstract

Uniportal thoracoscopic lateral basal segmentectomy is the most technically challenging anatomic segmentectomy,1-3 especially when it involves combined subsegmentectomy or sub-subsegmentectomy. Therefore, there are very few reports detailing its technical aspect.In this multimedia article, we describe a very complex uniportal thoracoscopic combined seg-sub-subsegmentectomy of RS9+10bii through the oblique fissure approach and the inferior pulmonary ligament approach, following a single-direction strategy4,5 to advance the procedure, utilizing the stem-branch method3,6 for segmental/subsegmental/sub-subsegmental structure tracking, and employing dual-display method, which comprises the intravenous ICG injection method and the inflation/deflation method, to identify intersegmental and inter-seg-sub-subsegmental planes.The operation lasted 169 min, with approximately 20 mL of blood loss. The patient experienced an active hemothorax and two spontaneous pneumothoraxes on postoperative days 1, 4, and 19, respectively, all of which resolved promptly after treatment. Histopathological examination of the specimen documented invasive non-mucinous adenocarcinoma with negative surgical margins and lymph nodes. The staging was determined as pT1bN0M0, stage IA2. During the 14-month follow-up period, there were no signs of tumor recurrence or metastasis observed. The FVC, FEV1, and FEV1%pred decreased by 11.9%, 12.5%, and 12.8%, respectively, at postoperative month 6.Complex basal segmentectomies, which necessitate combined subsegmental or sub-subsegmental resections, such as RS9+10bii, are feasible using the dual-display and combined approaches method. This method simplifies the steps of the very complex combined subsegmentectomy, averting the need for extensive lung resection. In addition, when performing these combined segmentectomies, precise anatomical dissection is crucial to prevent complications such as minor bronchopleural fistulas.