Thoracoscopic Segmentectomy Using 3D CT Simulation
利用CT重建3D成像实施的胸腔镜肺段切除术
General Thoracic Surgery
普通胸外科
In the field of respiratory surgery, lobectomy is now generally performed thoracoscopically, but in this department, we also conduct thoracoscopic segmentectomy. There are five pulmonary lobes, three on the right and two on the left. The standard method for treatment of lung cancer is lobectomy. Recently, however, with the spread of CT, early detection has been increasing. As a standard procedure, removing a large lobe even in the case of a small lung tumor is coming to be considered as excessive. Among these lesions, ground glass opacity lesions are thought to have an especially high possibility of being early lung cancer, and the view is spreading that it's acceptable to remove a small area without being limited to the earlier standard procedure. With this point of view, partial resection has come to be performed in a small area on the surface of the lung. However, if it happens to go deep into the lungs, partial resection is difficult. On the other hand, it's a waste to excise the whole pulmonary lobe when there are only five on both sides. This is when segmental resection is chosen.
肺外科手术时，通常可利用胸腔镜来实施肺叶切除术，但我们也利用胸腔镜来切除肺段。人肺共有5个肺叶即右肺3叶、左肺2叶。肺癌的标准手术方式是肺叶切除术。然而，近年来随着CT的广泛应用，即使是非常早期的微小肺部肿瘤，也能够被发现并诊断。对于这些早期的微小肿瘤，如采取肺叶切除术的话，切除范围就显得过大。上述微小肿瘤中，大部分磨玻璃阴影（GGO）病变是早期肺癌。另一方面，越来越多的观点认为切除更少的肺组织而非标准肺叶切除术就能治愈这些早期肺癌。病变如果位于肺的浅表部位，部分切除比较容易，但如果位于肺深部，部分切除就很困难，所以往往不得不采取肺叶切除术。因为人类也就5个肺叶，而且肺组织不可再生，因此这样做显然会损失过多的肺组织。所幸的是，我们在这种情况下可以选择肺段切除术。
The five lobes are further divided into areas 18 and segmental resection is the removal of these areas. However, pulmonary segmental resection is typically difficult due to the complex involvement of vessels and bronchi, so it's typically performed with thoracotomy. Yamagata University has been pioneering lung segmentectomy using an endoscope (thoracoscope). Until then, there were a very few reports of thoracoscopic segmentectomy, but these were limited to the so-called simple procedures. This is because for the greater part of segmentectomies, the blood vessels are complicated and it's difficult to incise the actual lung where each patient has differing anatomy, so it was considered necessary to perform a normal thoracotomy. However, there's a contradiction in that this results in a large surgical wound to resect a small area. Ideally resection of a small area should leave only a small scar. To solve this problem, the hospital started pioneering surgery simulation using 3D images produced by computer processing of CT.
解剖学上，人类的5个肺叶又可进一步划分为18个区域即肺段。然而，由于肺段的血管及支气管结构相当复杂而且存在个体差异，通常需要开胸才能完成肺段切除术。目前胸腔镜肺段切除术的报道还比较少，多数是比较简单的肺段。切除一小部分肺的同时又需要标准的开胸大切口，这显然得不偿失。为解决这一矛盾，山形大学很早就开始探究微创技术即胸腔镜来实现肺段切除的方法。大学附属医院率先利用计算机处理进行CT重建3D成像来精确引导肺段切除。
By mastering computer processing, accurately ascertaining the anatomy, and setting the area for resection correctly, it became possible to excise any complicated area whatever the type with a thoracoscope. Each segment is further divided into two or three subsegments, therefore the lungs are actually divided into 42 subsegments. With the addition of unique innovations, we can now freely combine these areas and subsegments for resection. It's possible to determine the optimal resection area for each patient, enabling so-called minute tailor-made surgery. So far we've conducted 300 segmentectomies. From an era of surgery requiring a large incision for even a small tumor to a small incision for a small tumor, it has become possible to perform operations that make sense from the physical point of view. The patient can now drink water on the evening of the day of surgery, and walking has become possible. We'll be pleased if you choose our precise and accurate thoracoscopic segmentectomy.
计算机处理能够精确还原解剖结构并确定切除范围，上述胸腔镜肺段切除的难点便迎刃而解，任何复杂的肺段切除都可以实现。而且，每个肺段又被进一步划分为2至3个亚段，肺实际上被分为42个亚段。通过计算机辅助，我们现在能够得心应手地组合这些亚段并切除，还可以做到对每个患者进行个体化评估来指导手术切除，正所谓是"量体裁衣、限量版"的手术。目前我们已经顺利完成300例肺段切除术。事实证明，通过"小切口"来切除"小病变"是完全有可能的:手术当天晚上患者就可以喝水甚至下地行走。我们很乐意为您实施这种精确的胸腔镜肺段切除手术。
Relevant diseases
相关疾病
This operation is suited mainly to lung cancer with tumor size of 2cm or less, metastatic lung cancer, and benign diseases. Depending on the characteristics of the CT shadow, lung cancers of around 3cm can also be removed.Also we are performing this operation even for babies or children so as to reserve the lung as much as possible.
这种手术主要针对直径小于2cm的肿瘤、转移性肺癌和良性肿瘤。某些CT表现特殊、直径3cm左右的肺癌也可切除。我们也为婴儿或儿童（需要尽可能保留肺组织）实施该手术。
Record of treatment using thoracoscopic segmentectomy
胸腔镜肺段切除术的治疗效果
Everybody who received lung cancer surgery at the hospital was discharged in good health. Nearly 70% of patients with a thoracotomy tube can have it removed the first postoperative day. Our long-term results are excellent. One hundred percent of cases involved a complete cure, with 5-year survival rate without recurrence, and with absolutely no signs of recurrence. Also, with lung cancer of a size where normally lobectomy would be necessary, there are cases where only segmental resection can be performed due to advanced age or insufficient lung function. In these cases, the 5-year survival rate without recurrence is 95.3%, which is very good. We see this as proof that the settings for resection area using CT simulation at the hospital are correct. Of course, the results of the peritoneoscopic lobectomy are also good, with a 5-year survival rate without recurrence of 97.2% and a 10-year survival rate of 94.1%
所有接受肺癌手术的患者均痊愈出院。近70%的患者在术后第1天即拔除胸腔引流管。长期随访的结果很满意。所有患者均治愈:5年生存率100%、无1例复发。此外，对于比较大的肺癌，尽管原则上需要做肺叶切除，但如果高龄或肺功能很差，也可以选择肺段切除术。这些病例的治疗效果也很不错：5年无复发率为95.3%。由此可见，利用计算机处理CT重建技术来精确引导手术切除非常有效。当然，胸腔镜肺叶切除的效果也很理想:5年无复发率为97.2%、10年生存率为94.1%。
These excellent results are regarded as the pinnacle of thoracic surgery overseas, and they're attracting global attention, with numerous presentations being adopted every year at academic conferences. Now, we're increasing our activities towards wider adoption of the procedure, providing instruction in the operation, lectures and so on at hospitals overseas.
上述精巧的手术技术被认为是胸外科学中的顶尖成果，引起全球性的瞩目。目前，我们正在积极推广该技术，每年都在国际学术会议上演讲交流，并在海外的医院演示手术过程。
