Anatomy Of Right Pulmonary Bronchus And Arteriovenous Artery Based On 3D Reconstruction

Purpose:Analyze the three-dimensional anatomical model of the right lung lobe,and count the common and rare types of bronchial and blood vessel branch morphological variations.Methods:A retrospective analysis of 100 patients with small pulmonary nodules who were to undergo partial pneumonectomy in the Department of Thoracic Surgery in our hospital from January 2019 to March 2021.The lung CT image data was applied to three-dimensional reconstruction software（IQQA-3D）before operation.Simulate reconstruction of the lung anatomical structure,and use the reconstructed model for statistics and analysis of the morphology of the right lobe bronchus and blood vessel branches,and compare with previous research data.Results:Right lung bronchus:The right upper lobe bronchus has three branches accounted for 49%,and two branches accounted for 51%.Among the three branches,the normal three branch types（B¹,B²,B³）are the most common,accounting for 38%,and the abnormal type accounts for 11%.The second branch accounted for 51%,of which the normal second branch accounted for 30%,and the abnormal second branch accounted for 21%.The middle lobe bronchi are mostly single stems,with the two-branched type more common in 99%,and the three-branched type accounting for 1%.There is also a case of three-branch type B⁴a,B⁴b+B⁵b,B⁵a type.In the lower lobe of the right lung,99%of the patients with dorsal bronchus originated as a single trunk,of which the two-branched type accounted for 92%,and the B⁶a+b and B⁶c types were the most common,accounting for 81%.Only one patient observed that B⁶ originated as double stem B⁶a+c,B⁶b type.The three-branch type is the most common type of basal bronchial trunk（87%）,followed by the two-branch type（10%）.Among them,B⁷,B⁸,and B⁹⁺¹⁰ are the most,accounting for 70%.Right pulmonary artery:anterior trunk+ascending artery type is more common in right upper pulmonary artery classification,accounting for 82%,anterior trunk type,upper anterior trunk+lower anterior trunk type,upper anterior trunk+lower anterior trunk+ascending artery type are relatively rare,accounting for respectively 10%,5%,3%.The two-branched arteries of the right middle lobe are the most common（57%）,and the single-branched arteries account for43%.The relative spatial position of the branches of the middle lobe artery and A⁶ is complicated,which can be higher,lower or even with A⁶.A⁶ is the most common type with single stem（83%）,and double stem accounts for 17%.Among the single stem type,A⁶c and A⁶a+b two-branch type are the most common（46%）,and the three-branch type only accounts for 4%.Among the basilar artery trunks,the three-branch type A⁷,A⁸,A⁹⁺¹⁰（42%）and the two-branch type A⁷⁺⁸,A⁹⁺¹⁰（37%）are the most common.No patients whose branches of the right middle pulmonary artery originated from the basilar artery trunk were not observed.Right pulmonary vein:The three-vessel type is the most common vein in the right upper lobe（82%）,with type III accounting for 30%,type IV accounting for 28%,type I accounting for 26%,and type II accounting for 16%.The one type of vein in the right middle lobe is the most common（49%）,followed by the two-vessel type（38%）,and the three-vessel type is the least common（13%）.V⁶ is almost a single dry type（99%）,of which V⁶a and V⁶b+c account for up to 71%.V⁸⁺⁹,V¹⁰ and V⁸,V⁹⁺¹⁰ are the most common in the right basal pulmonary vein trunk, accounting for 42%and 28%,respectively.The basal vein of 30 patients was also observed to be of split type.Conclusion:The structure of the blood vessels and bronchi of the right lobe of the lung is complex,and there are many morphological variations of the branches.Our data can provide valuable reference resources for thoracic surgeons to perform anatomical segmental pneumonectomy.