Observation of bronchial anatomy and variation of the middle lobe of the right lung based on three-dimensional reconstruction of lung CT.

Abstract

Purpose: To explore the anatomical types and variations of lung segments and subsegment bronchi based on CT 3D reconstruction technology, and to provide anatomical theoretical support for thoracic surgeons in terms of surgical techniques.

Methods: The 3D CT reconstructed images of 541 patients were retrospectively analyzed. We explored the anatomical structure of the bronchi in the middle lobe of the right lung, sorted out the variations, and classified them in detail according to different bronchial types.

Results: In the CT 3D reconstruction of 541 patients, the bronchial anatomical types of the right middle lobe were divided into two types. There were 530 cases (98.0%) of two-branched type and 11 cases (2.0%) of three-branched type, and no four-branched type was found in the data of this paper. In addition, the spatial relationship between B₄ and B₅, and the spatial relationship between subsegmental bronchi B_4a, B_4b, B_5a, and B_5b are analyzed. The most common anatomical type and spatial relationship of the right middle lobe bronchi in the two-branched type were B₄ and B₅ in the external-internal relationship, B_4a and B_4b in the external-internal relationship, and B_5a and B_5b in the upper and lower relationship, and this subtype was 416 cases (76.9%). In addition, 23 cases (3.9%) were found to have a spatial relationship between B₄ and B₅ in the right middle lobe similar to the lingual bronchial subtype in the left upper lobe.

Conclusion: We used a large number of CT 3D reconstructed images to explore the anatomical types and variations of the bronchi in the middle lobe of the right lung. Thoracic surgeons can use our data to guide increasingly delicate lobectomy and segmentectomy.