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| 基于Mimics软件的成年患者支气管解剖学特征与双腔支气管导管型号的差异 |
| Analysis of bronchial anatomy in adults by using Mimics software and the difference in selecting the size of double-lumen endobronchial tube |
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| DOI：10.12089/jca.2023.02.004 |
| 中文关键词: 双腔支气管导管 支气管长度 支气管内径 Mimics软件 |
| 英文关键词: Double-lumen endobronchial tube Bronchial length Bronchial diameter Mimics software |
| 基金项目:南京市卫生科技发展专项资金重点课题（ZKX20017）；南京市青年卫生人才项目（QRX17013）；南京大学医院管理研究所课题项目和南京鼓楼医院医学发展医疗救助基金会资助项目（NDYG2020027） |
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| 中文摘要: |
目的 通过Mimics软件构建的支气管三维模型分析成年患者支气管解剖学特征，为临床合理选择双腔支气管导管（DLT）提供参考。
方法 第1部分，回顾性分析2021年4—7月行胸部CT检查的成年患者256例，采用Mimics软件构建支气管三维模型并进行多平面重建，测量右支气管内径（RBD）、右支气管长度（RBL和RMSBL）、左支气管内径（LBD）、左支气管长度（LBL），并与临床常用型号DLT相关参数进行比较。第2部分，选择2021年7—11月择期全麻下行左肺手术的成年患者60例，随机分为两组：Mimics软件测量组（M组）和传统方法组（C组），每组30例。M组根据Mimics软件测量的支气管长度和内径值选择导管型号；C组根据患者的性别、身高选择导管型号。计算DLT型号首次选择准确率。
结果 第1部分，RBL和RMSBL变异系数较大，右支气管开口于隆突及以上患者3例（1.2%），243例（95%）患者RMSBL≤30 mm，其中50例RMSBL≤18.1 mm。LBD≤35和37 Fr导管外径值以及RBD≤35和37 Fr导管外径值的患者均为女性，女性患者支气管内径≤39 Fr导管外径的人数以及RMSBL≤35 Fr导管支气管套囊近端到侧孔近端距离（18.1 mm）的比例均明显高于男性（P<0.05）。第2部分，M组DLT型号首次选择准确率明显高于C组（P<0.05）。
结论 成年患者支气管解剖存在显著个体差异，术前运用Mimics软件测定支气管解剖参数有益于DLT型号个体化选择。 |
| 英文摘要: |
Objective To analyse the bronchial anatomy in adults based on the three-dimensional model by using Mimics software and provide assistance for the appropriate selection of double-lumen endobronchial tube (DLT) in clinic.
Methods In part 1, a total of 256 adult patients undergoing thoracic computed tomography (CT) scans from April to July 2021 were enrolled. The three-dimensional model of bronchus was constructed by Mimics software and the following parameters were analyzed by multi-planar reconstruction: right bronchus internal diameter (RBD), right bronchial length (RBL and RMSBL), left bronchus internal diameter (LBD), and left bronchial length (LBL). The bronchial anatomical parameters were compared with the indices of DLT. In part 2, 60 patients scheduled for elective left lung surgery were randomly divided into two groups: traditional method group (group C) and Mimics software measurement group (group M), 30 patients in each group. In group C, the DLT size was selected according to the patient's gender and height. In group M, the DLT size was selected based on bronchial length and inner diameter measured by the Mimics software. The accuracy of selecting DLT size was compared between the two groups.
Results In part 1, the variance RBL and RMSBL was found, 3 patients (1.2%) had right bronchial opening at level of bronchial carina and above. In addition, the values of RMSBL were no more than 30 mm in 243 patients (95%), among whom the values of RMSBL in 50 patients were less than 18.1 mm. Patients with RBD or LBD less than the outer diameter DLT of 35 Fr and 37 Fr were all female. Compared with male patients, female patients with bronchial inner diameter less than or equal to the outer diameter of 39 Fr DLT. Similarly, more female patients with RMSBL less than or equal to the distance (18.1 mm) from the proximal end of the 35 Fr catheter bronchial cuff to the proximal end of the lateral foramen (P < 0.05). In part 2, the accuracy of DLT size selected for the first time in group M was significantly higher than that in group C (P < 0.05).
Conclusion The anatomy of the bronchi differs, and preoperative measurement of bronchial anatomical parameters by using Mimics software is conductive to the selection of an appropriate size DLT. |
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