The Research And Development Of 3D Digital Lung Software And The Application In Preoperative Planning Of Patients With Multiple Pulmonary Nodules And Poor Pulmonary Function

Objective: Explore the experience and understanding of 3D Digital Lung Automatic Partition of Pulmonary Segments/Virtual Surgery Software(abbr.3D Digital Lung Software)used to identify the pulmonary nodules location of patients with multiple pulmonary nodules and poor pulmonary function,to estimate the impact of the pulmonary segmentectomy on the postoperative pulmonary function,to guide the VATS of simultaneous multiple segmental resection.Methods: Ten patients with multiple pulmonary nodules in one side lung,meanwhile with a history of single lung lobectomy/sublobectomy or the pulmonary function at the critical value of lung surgery because of Chronic bronchitis,emphysema or other lung diseases,were included in PLA 174 th hospital between December 2015 to February2017.A 320-slice volumetric CT scanner was used to the CT angiography(CTA)of the pulmonary artery.The data of CT images were imported into the 3D digital lung software that was researched and developed by Xiamen Qiang Ben Science and Technology Company.The 3D reconstruction of digital virtual lung was completed by this software based on those data.At the same time the software completed the automatic segmentation of the lung based on the pulmonary artery system and the 3D reconstruction of the pulmonary nodules.The 3D digital lung software calculated the volume proportion of the intended removal(segmental lesions)to the whole lung,estimated the effect of surgery on forced expired volume in one second(FEV1),and the patient’s tolerance ability to surgery.After the preoperative planning,the patients received multiple pulmonary segmental/ subsegmental resection under the general anesthesia by video-assisted thoracoscopic surgery(VATS).Results: The 3D reconstruction of the pulmonary arteries reached 5 levels in 10 patients.And the software automatically identified out the lung segment/ subsegment to show the lung nodules of lung segment/subsegment.The preselection lung volume of 10 patients accounted for 13%-27% of total lung volume.The software estimated FEV1 as 1.16-1.65 L which can tolerate the operation.The 10 patients were successfully performed surgery of multiple pulmonary segmental/ subsegmental resection under the general anesthesia by VATS.The software located lung nodules from the resection of pulmonary segments during operation immediately.Then we sent them to the rapid pathological examination for diagnosis.After operation,the patients recovered well,and had no respiratory insufficiency.Hospitalization day was 4-5 days.Conclusion: The 3D digital pulmonary software can not only automatically identify the pulmonary segments,precisely position the pulmonary nodule,show the relationship among the target pulmonary segments artery,vein,bronchus and the surrounding artery,vein,and bronchus,but also calculate the volume of the pulmonary segments,estimate the impact of the pulmonary segmentectomy on the FEV1.It is useful for precise evaluation of the tolerant capacity of multiple pulmonary nodules in patients with unstaged multiple pulmonary segments.