肺静脉跨叶现象及其在肺叶切除术中的临床意义

BACKGROUND AND OBJECTIVE: Lobectomy is the main treatment strategy for early lung cancer. However, there are many anatomical variations in the lungs, especially some pulmonary veins will deviate from the normal position, and even cross the border of lob to enter the adjacent lobes, which increases the difficulty and risk of lobectomy. This study aims to analyze the variation types and frequency of pulmonary translobar veins, and further investigate its clinical significance in lobectomy. METHODS: This study retrospectively included 916 patients who underwent lung resection in our center from December 2018 to November 2019, and selected 310 patients who underwent enhanced chest computed tomography (CT) examination before surgery. Enhanced chest CT and three-dimensional computed tomography bronchography and angiography (3D-CTBA) of these patients were applied to analyze the types and frequency of translobar veins. Further, 48 cases of lobectomy whose operation areas involved translobar veins were further screened out of 916 surgical cases (Among them, the translobar veins of 36 subjects were cut off and the other 12 patients were reserved). The effect of two different treatments on remaining lung was observed by surgical video. RESULTS: A total of 26 translobar veins patterns were identified with an overall incidence of 82.26%, much greater in the right than in the left lung (80.65% vs 11.94%). The major types (frequency > 5%) in the right lung include: the VX2 (5.48%) that flows into the inferior pulmonary vein behind the intermediate bronchus, the V(3)b (58.39%) that converges the venous branches of the upper and middle lobe, the VX(4) that flows into the V(2) (13.23%) or V(3) (12.58%) in the horizontal fissure, the VX(4) (8.71%) or VX(5) (7.42%) that flows into the left atrium beneath the middle lobe bronchus, and the VX(6) that flows into V(2) in the Oblique fissure. The major types in the left lung include the common trunk (9.36%) of the superior and inferior pulmonary vein, of which 4.84% are greater than 1 cm in length. Compared to the preserved group, circulatory function of the remaining lung was impaired in the severed group, with the impaired area failing to collapse long after ventilation is stopped, the incidence of postoperative hemoptysis (13.89% vs 0.00%) and pulmonary air leakage (19.44% vs 8.33%) increased, the postoperative hospital stay [(4.72±1.86) d vs (3.92±1.62) d] was longer, and the total drainage during 3 days after operation [(705.42±265.02) mL vs (604.92±229.64) mL] was more, but the difference is not statistically significant. CONCLUSION: There are a variety of types of translobar pulmonary veins and some of them have a high incidence; However, most of the translobar veins were neglected in surgery, which could adversely affect the safety of surgery and the recovery of patients after surgery.