4．肺区域・亜区域切除における術前計画と血管・気管支・区域間処理

Presurgical Planning and Intraoperative Management of Segmental Vessels and Bronchi during Lung Segmentectomies

肺区域・亜区域切除術は，末梢小型肺癌や転移性肺腫瘍に対する積極的縮小手術あるいは低肺機能ハイリスク例に対する消極的縮小手術として選択されることが多い．

Lung segmentectomy is one of the important options for early lung cancers and metastatic lung tumors. And, segmentectomy is expected to preserve pulmonary functions. However, sometimes it is difficult to identify segmental branches of vessels and bronchi and intersegmental planes during segmentectomies, because segmental anatomies are different from patient to patient and intersegmental plane is not visible. Therefore, preoperative and intraoperative confirmation of the segmental anatomy is important to perform segmentectomies safely and precisely. In this paper, we describe the preoperative 3-dimensional （3D） simulations and intraoperative 3D navigations to understand precise segmental anatomies of patients. Also, we introduce some major techniques for identification of intersegmental planes, and how to cut intersegmental planes.