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  • Title: [Translobar Phenomenon of Pulmonary Veins and Its Clinical Significance
in Lobectomy].
    Author: Xu W, Li Z, He Z, Xu J, Wu W, Chen L.
    Journal: Zhongguo Fei Ai Za Zhi; 2021 Feb 20; 24(2):99-107. PubMed ID: 33478198.
    Abstract:
    BACKGROUND: 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 V3b (58.39%) that converges the venous branches of the upper and middle lobe, the VX4 that flows into the V2 (13.23%) or V3 (12.58%) in the horizontal fissure, the VX4 (8.71%) or VX5 (7.42%) that flows into the left atrium beneath the middle lobe bronchus, and the VX6 that flows into V2 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. CONCLUSIONS: 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. 【中文题目：肺静脉跨叶现象及其在肺叶切除术中的
临床意义】 【中文摘要：背景与目的 肺叶切除术是早期肺癌的主要治疗方式，然而肺部解剖变异繁多，尤其是部分肺静脉会脱离正常解剖位置，甚至跨越肺叶边界进入相邻肺叶，这增加了手术的难度和风险。本研究旨在全面分析肺跨叶静脉的类型和发生频率，并进一步探究其在肺叶切除术中的临床意义。方法 纳入南京医科大学第一附属医院2018年12月-2019年11月期间行肺部手术的患者916例，筛选出术前行胸部增强计算机断层扫描（computed tomography, CT）检查的病例310例，应用这些患者的胸部增强CT和三维CT支气管血管成像（three-dimensional computed tomography bronchography and angiography, 3D-CTBA）对跨叶静脉的类型及频率进行分析。进一步从916例手术病例中筛选出行肺叶切除术且手术区域涉及到跨叶静脉的病例共48例（切断组36例，保留组12例），通过手术录像观察两种不同的处理方式对余肺叶的影响。结果 共发现26种肺跨叶静脉模式，总发生率为82.26%，右肺远大于左肺（80.65% vs 11.94%）。右肺中主要类型（频率>5%）包括：中间支气管后方汇入下肺静脉的VX2（5.48%）、汇集上、下叶静脉属支的叶间静脉V3b（58.39%）、水平裂内汇入V2（13.23%）或V3（12.58%）的VX4、中叶支气管下方汇入左心房的VX4（8.71%）或VX5（7.42%）、肺裂内汇入V2的VX6（29.68%）；左肺中主要类型为整支上肺静脉汇入下肺静脉形成共干的左肺静脉（9.36%），其中共干长度>1 cm的占4.84%。观察手术录像发现：与保留组相比，切断组中患者其余肺叶的血液循环功能受到影响（表现为受影响区域停止通气后长时间无法萎陷），术后咯血（13.89% vs 0.00%）和肺漏气（19.44% vs 8.33%）发生率增加，术后住院时间［(4.72±1.86) d vs (3.92±1.62) d］较长，术后3 d引流量［(705.42±265.02) mL vs (604.92±229.64) mL］较多，但差异无统计学意义（P>0.05）。结论 肺静脉跨叶现象种类繁多，且部分类型发生率较高。然而大部分跨叶静脉在手术中被忽视，这可能对手术安全和患者术后恢复产生不利影响。】 【中文关键词：肺结节；肺跨叶静脉；肺叶切除术；3D-CTBA；解剖变异】.
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