| Objective:In clinical practice.Various patterns that are different from the branching pattern of segmental bronchi in anatomy books and articles often appear in thoracic CT examinations for patients.The precise classification of the segmental bronchi for individual patients provides doctors with more precise guidance.This study statistically analyzed the branching patterns of segmental bronchi in Chinese based on Somatom Definition Flash CT and explored the main rules and gender differences of the branching patterns of segmental bronchi in Chinese,in order to provide reference for the implementation of precision medicine in the aspects of segmentectomy,imaging diagnosis,pathological biopsy and observation of the target.Methods:After the routine thoracic CT examinations for patients based on Somatom Definition Flash CT(Siemens,Forchheim,Germany),the image post-processing methods with syngovia post-processing workstation(Siemens,Forchheim,Germany)was applied to reconstruct the data in three-dimensions.2019 cases with favorable conditions,good display and no missing parts in each case were selected.The directions of travel,openings,and ramifications of the segmental bronchi via three-dimensional reconstruction in bronchial tree and CT virtual bronchoscopy was observed,assisted with lung window images.Then the branching patterns of segmental bronchi was comprehensively determined.Then the composition ratios of the branching patterns of segmental bronchi was statistically analyzed.Finally,this study statistically tested whether there are gender differences between composition ratios of the branching patterns of segmental bronchi.Results:The right upper lobe bronchus contains 6 types.Type I is a trifurcation type,which contains three branches of the apical,posterior and anterior segmental bronchus,accounting for 65.87%.Type ?,in which the apical and the posterior segmental bronchus share a common stem,accounts for 13.42%.Type ?,in which the anterior and the posterior segmental bronchus share a common stem,accounts for 9.11%.Type?,in which the apical and the anterior segmental bronchus share a common stem,accounts for 6.49%,Type V is a tetrafurcation type,which contains four branches of the apical,posterior,anterior and the so called"lateral"segmental bronchus in this study,accounting for 3.47%,Type VI contains two apical segmental bronchi,which accounts for 1.63%.The right middle lobe bronchus is divided into the lateral segmental bronchus and the medial segmental bronchus.The right lower lobe bronchus contains 4 types.Type I,in which the basal segmental bronchus is divided into the medial basal,anterior basal,common stem of lateral and posterior basal segmental bronchus,accounts for 66.47%.Type II,in which the basal segmental bronchus is divided into the medial basal,posterior basal,common stem of anterior and lateral basal segmental bronchus,accounts for 17.73%.Type ?,in which the basal segmental bronchus is divided into the common stem of medial and anterior basal segmental bronchus,and the common stem of lateral and posterior basal segmental bronchus,accounts for 9.06%.Type IV,in which the basal segmental bronchus is divided into the medial basal,the common stem of anterior,lateral and posterior basal segmental bronchus,accounts for 6.74%.The left upper lobe bronchus contains 4 types.Type ?,in which the apical and the posterior segmental bronchus share a common stem,accounts for 80.14%.Type II is a trifurcation type,which contains three branches of the apical,posterior and anterior segmental bronchus,accounting for 11.64%.Type ?,in which the apical and the anterior segmental bronchus share a common stem,accounts for 7.38%.Type ?contains two apical segmental bronchi.which accounts for 0.84%.The left lower lobe bronchus contains 4 types.Type I,in which the basal segmental bronchus is divided into the common stem of medial and anterior basal segmental bronchus,and the common stem of lateral and posterior basal segmental bronchus,accounts for 82.22%.Type II,in which the basal segmental bronchus is divided into the lateral basal,the posterior basal,and the common stem of medial and anterior basal segmental bronchus,accounts for 13.92%.Type III,in which the basal segmental bronchus is divided into the medial basal,the posterior basal and the common stem of anterior and lateral basal segmental bronchus,accounts for 3.22%.Type IV,in which the basal segmental bronchus is divided into the medial basal and the common stem of anterior,lateral and posterior basal segmental bronchus,accounts for 0.64%.It is found that there is no significant difference in the overall composition ratios of the branching patterns of segmental bronchi of the right upper lobe and the left lower lobe between different genders.And there are statistically significant differences in the overall composition ratios of the branching patterns of segmental bronchi of the right lower lobe and the left upper lobe between different genders.Among them,the chi-square test is performed on the gender difference of the total composition ratios of the branching patterns in the right lower lobe of the lung.The result is P<0.001,which has very significant statistical difference.Conclusions:1.The sample size of this study reaches 2019 cases.Compared with previous studies,the sample size of this study increases significantly.This study found patterns of segmental bronchi that were not discovered by the predecessors.So it will be easier to draw the main rules of the branching patterns of segmental bronchi in Chinese.2.For the right upper lobe bronchus,due to the presence of short common stem,tetrafurcation.,two apical segmental bronchi,tracheobronchial bronclhus.,etc.,34.13%of the data does not apply to naming pattern for the trifurcation of the apical,anterior and posterior segmental bronchus.3.For the right middle lobe bronchus,it is fixedly branched into the lateral segmental bronchus and the medial segmental bronchus.4.For the rnght lower lobe bronchus,33.53%of the data does not apply to the naming pattern for the medial basal,the anterior basal,the lateral basal,and the posterior basal segmental bronchus due to the presence of common stem of anternor basal and lateral basal segmental bronchus,and the common stem of medial basal and anternor basal segmental bronchus.5.For the superior division of the left upper lobe bronchus,due to the presence of two apical segmental bronchi,trifurcation,and the common stem of apical and anterior segmental bronchus,etc.,19.86%of the data does not apply to the naming pattern for apicoposterior and anterior segmental bronchus.6.Forthe left lower lobe bronchus,82.22%of the data has common stem of lateral basal and posterior basal segmental bronchus.After the common stem descends for a distance,it further branches into the lateral basal and the posternor basal segmental bronchus.7.This study is the first to examine whether there are gender differences in branching patterns of segmental bronchi.It is found that there is no significant difference in the overall composition ratios of the branching patterns of segmental bronchi of the right upper lobe and the left lower lobe between different genders.And there are statistically significant differences in the overall composition ratios of the branching patterns of segmental bronchi of the right lower lobe and the left upper lobe between different genders.Among them,the chi-square test is performed on the gender difference of the total composition ratios of the branching patterns in the right lower lobe of the lung.The result is P<0.001,which has very significant statistical difference.8.This study used CT virtual bronchoscopy via Somatom Definition Flash CT,which greatly improves the image quality and shows anatomical details of segmental bronchi in an unprecedented way compared with previous research methods.It's closer to the true distribution of the branching patterns in the population.So it's helpful for anatomical study of segmental bronchi.9.The findings of this study are beneficial to the thoracic surgeons to understand the possible bronchial anatomy of each patient and then make different surgical plans,which is helpful for accurate and smooth implementation of anatomical segmentectomy and other surgeries.Clinicians get benefits to accurately locate the segmental bronchi during imaging diagnosis,pathological biopsy and observation of the target,in order to provide reference for the implementation of precision medicine.10.Accurate system for automatic naming of bronchial branches,bronchoscopic navigation system,and automated system for tracheobronchial tree matching and labelling also require conclusions of this study as reference. |
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