胸腔镜肺段切除术解剖基础

,LIN Zongwu, Department of Thoracic Surgery, Zhongshan Hospital,复旦大学附属中山医院胸外科,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,LIN Zongwu, Department of Thoracic Surgery, Zhongshan Hospital,复旦大学附属中山医院胸外科,胸腔镜肺段切除术解剖根底,复旦大学附属中山医院胸外科,林宗武 袁云锋,命名,记忆,学习,交流,Pulmonary Segments,左上肺,固有段,S1+2+3,尖后段,S1+2,前段,S3,舌段,S4+5,上舌段,S4,下舌段,S5,左上肺,左下肺,背段,S6,背段下段,S*,基底段,S8-10,前基底段,S8,外基底段,S9,后基底段,S10,左下肺,右上肺,尖段,S1,后段,S2,前段,S3,右上肺,右中肺,外侧段,S4,内侧段,S5,右中肺,右下肺,背段,S6,背段下段,S*,基底段,S8-10,内基底段,S7,前基底段,S8,外基底段,S9,后基底段,S10,右下肺,左上肺解剖,左上肺支气管解剖,左上肺,固有段支气管,尖后段支气管,B1+2,尖亚段,B1+2a,后亚段,B1+2b,外亚段,B1+2c,前段支气管,B3,外亚段支气管,B3a,内亚段支气管,B3b,上亚段支气管,B3c,舌段支气管,上舌段支气管,B4,外亚段支气客,B4a,内亚段支气管,B4b,下舌段支气管,B5,上亚段支气管,B5a,下亚段支气管,B5b,左上肺动脉解剖,左上肺动脉,固有段动脉,A1+2+3,尖后段动脉,A1+2,尖亚段动脉,A1+2a,后亚段动脉,A1+2b,外亚段动脉,A1+2c,前段动脉,A3,外亚段动脉,A3a,内亚段动脉,A3b,上亚段动脉,A3c,舌段动脉,A4+5,上舌段动脉,A4,外亚段动脉,A4a,内亚段动脉,A4b,下舌段动脉,A5,上亚段动脉,A5a,下亚段动脉,A5b,左上肺静脉解剖,左上肺静脉,固有段静脉,V1+2+3,尖后段静脉,V1+2,V1+2a,：,S1+2a,和,S3c,之间,V1+2b,：,S1+2a,和,S1+2b,之间,V1+2c,：,S1+2b,和,S1+2c,之间,V1+2d,：,S1+2c,和,S3a,之间,前段静脉,V3,V3a,：,S3a,和,S3b,之间,V3b,：,S3b,和,S4b,之间,V3c,：,S3b,和,S3c,之间,舌段静脉,V4+5,上舌段静脉,V4,V4a,：,S4a,和,S4b,之间,V4b,：,S4b,和,S5a,之间,下舌段静脉,V5,V5a,：,S5a,和,S5b,之间,V5b,：,S5b,下方,左上肺解剖图,支气管,左上肺,右上肺,左下肺,右下肺,动脉,左上肺,右上肺,左下肺,右下肺,静脉,左上肺,右上肺,左下肺,右下肺,段间的判断,段间裂,膨胀萎陷法,解剖根底,左上肺的解剖,左上肺解剖,B1+2,B3,B4,B5,A1,残端,Med .,A4+5,A3,V1+2,V3,V4+5,右上肺的解剖,右下肺的解剖,左下肺的解剖,难点：变异,肺段变异,For example:,左上肺前段支气管,B,3,a, B,3,b+c 90%,others 10%,左上肺前段支气管,B3,左上肺前段支气管,B3,左上肺前段支气管,B3,肺段变异,For example: 左上肺,尖后,段支气管,B,1+2,a+b, B,1+2,c 65%,B,1+2,a, B,1+2,b+c & others 35%,左上肺固有段支气管,B1+2,左上肺尖后段支气管,B1+2,左上肺尖后段支气管,B1+2,肺段变异照片,Artery variation,Lower lobe,middle lobe,upper lobe,A6,A2,A4,A5,Uniportal VATS right lower lobectomy,Artery variation,Lower lobe,middle lobe,upper lobe,A2,A6 stump,Uniportal VATS right lower lobectomy,Vein variation,V1+2+3 stump,V4+5 stump,IPV,LULB,LLLB,Uniportal VATS left upper lobectomy,Vein variation,IPV,V6,V2,Bronchus variation in LLL,After left upper lobectomy,Bronchus,stump,Bronchus,stump,Open surgery Left upper lobectomy,术前三维重建,常用软件,1. Mimics,for Windows,2. Osirix,for Mac OS,with Lite Version,3. DeepInsight,Example 1,a pure 8-mm GGO nodule within the Left lower lobe,Example 1,Example 1 : LS,6,+ S*,LS,6,+ S*,Tumor ( between LS,6,& LS* ),S,6,V,6,b,S*,Tumor,Example 1 : LS,6,+ S*,Example 2,a pure 8-mm GGO nodule within the right lower lobe,Example 2,Example 2 : RS,6,+ S,8,a,RS,6,+ S,8,a,Tumor ( between RS,6,& RS,8,a ),A,6,V,6,b,A,8,a,Tumor,Thanks!,