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一例胸腔鏡右肺中葉手術(shù)中，4厘米腫瘤成功切除。然而，在切除中葉后，未能發(fā)現(xiàn)右肺上葉靜脈，引起了困惑。 最初懷疑在切除中葉靜脈時是否誤切了右上肺靜脈，但經(jīng)過仔細(xì)檢查確認(rèn)，剛剛切斷的靜脈確實是中葉靜脈，其走行路徑清晰可見，不可能出錯。 在進(jìn)一步打開縱隔胸膜時，仍未能發(fā)現(xiàn)右上肺靜脈的蹤跡，這讓人擔(dān)心是否需要進(jìn)行右上葉切除。 馬上電腦前仔細(xì)閱讀CT發(fā)現(xiàn)，患者右上肺相對較小，右上肺靜脈較細(xì)，并且其走行在肺動脈后方匯入左心房，與大多數(shù)情況下在肺動脈前方匯入左心房的情況不同。 因此，右上肺靜脈并非“消失”，而是由于其隱蔽的解剖位置而難以尋找，可以說是“隱身”了。 肺葉切除手術(shù)也需要肺段切除手術(shù)一樣，術(shù)前仔細(xì)閱片，以確保手術(shù)精準(zhǔn)。任何手術(shù)都不能馬虎！ 以下是此患者的CT圖片： During a thoracoscopic right middle lobe resection, a 4 cm middle lobe tumor was identified and successfully removed. However, after the middle lobe was excised, we were unable to locate the right upper lobe vein, which puzzled us. Initially suspected as an error in identifying the middle lobe vein during resection, upon careful examination, it was confirmed that the vein just cut was indeed the middle lobe vein, with its course clearly visible and correct. Further exploration of the mediastinal pleura failed to reveal any trace of the right upper lobe vein, raising concerns about the necessity for right upper lobe resection. Subsequent CT imaging revealed that the patient's right upper lung was relatively small, and the right upper lobe vein was finer in size, with its path to the left atrium situated behind the pulmonary artery, unlike the typical anterior position. Therefore, the right upper lobe vein had not "disappeared" but was rather challenging to detect due to its inconspicuous anatomical location—it was "invisible." This surgical experience reminded us that lung lobe resections require the same meticulous preoperative imaging review as segmental lung surgeries to ensure surgical precision. There is no room for carelessness in any surgical procedure!
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