Tian Hao, Lei Xu, Si-Ming Jiang, Min Zhang, Ming-jian Ge
{"title":"右上肺叶切除术右中叶静脉汇流变化的解剖分型及临床意义：三维重建研究","authors":"Tian Hao, Lei Xu, Si-Ming Jiang, Min Zhang, Ming-jian Ge","doi":"10.1111/1440-1681.70058","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Anatomical variations of the right middle lobe (RML) veins pose significant risks during video-assisted thoracoscopic right upper lobectomy (RUL), where unrecognised veins traversing the horizontal fissure may be injured, compromising venous drainage. While 3D reconstruction aids surgical planning, a comprehensive classification system for RML venous confluences was lacking.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective cohort study analysed 2007 patients undergoing lung surgery (2017–2023) using preoperative CT-based 3D-CT bronchography and angiography (3D-CTBA; Mimics 21.0). Two thoracic surgeons independently classified RML veins (V<sup>4</sup>a, V<sup>4</sup>b, V<sup>5</sup>a, V<sup>5</sup>b) by drainage location: horizontal fissure (H-type), anterior mediastinal (A-type), or oblique fissure (O-type). Disagreements were resolved by a radiologist. Descriptive statistics characterised anatomical patterns.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Analysis revealed complex venous drainage, with 31.83% (<i>n</i> = 639) demonstrating clinically critical H-type variations (confluencing into horizontal fissure). These were subclassified as HA (30.69%), HO (0.34%), and HAO (0.79%) patterns. V<sup>4</sup>a* traversed the fissure most frequently (29.07%), draining into upper lobe veins (V<sup>3</sup>b, V<sup>3</sup>a, V<sup>2</sup>c), while V<sup>4</sup>b* (2.86%) and V<sup>5</sup>a* (5.50%) exhibited lower traversal rates. No V<sup>5</sup>b* traversed the horizontal fissure. Rare drainage into the inferior pulmonary vein (IPV; V<sup>4</sup>a: 2.59%) or left atrium (0.20%) was observed, and the two-branch venous pattern predominated (42.87%). Previously unreported variants included downward-displaced RS<sup>3</sup> (<i>n</i> = 10) and V<sup>6</sup> → superior pulmonary vein drainage (<i>n</i> = 2). Intraoperative validation confirmed 3D-CTBA classification accuracy.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>This large-scale study establishes the novel HAO classification system for RML venous anatomy, revealing a high prevalence (31.83%) of H-type variations that critically impact RUL safety. Preoperative 3D-CTBA using this framework enables tailored surgical strategies to preserve RML veins traversing the horizontal fissure, reducing injury risks and postoperative complications.</p>\n </section>\n </div>","PeriodicalId":50684,"journal":{"name":"Clinical and Experimental Pharmacology and Physiology","volume":"52 9","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Anatomical Classification and Clinical Significance of Right Middle Lobe Vein Confluence Variations in Right Upper Lobectomy: A Three-Dimensional Reconstruction Study\",\"authors\":\"Tian Hao, Lei Xu, Si-Ming Jiang, Min Zhang, Ming-jian Ge\",\"doi\":\"10.1111/1440-1681.70058\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Anatomical variations of the right middle lobe (RML) veins pose significant risks during video-assisted thoracoscopic right upper lobectomy (RUL), where unrecognised veins traversing the horizontal fissure may be injured, compromising venous drainage. While 3D reconstruction aids surgical planning, a comprehensive classification system for RML venous confluences was lacking.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This retrospective cohort study analysed 2007 patients undergoing lung surgery (2017–2023) using preoperative CT-based 3D-CT bronchography and angiography (3D-CTBA; Mimics 21.0). Two thoracic surgeons independently classified RML veins (V<sup>4</sup>a, V<sup>4</sup>b, V<sup>5</sup>a, V<sup>5</sup>b) by drainage location: horizontal fissure (H-type), anterior mediastinal (A-type), or oblique fissure (O-type). Disagreements were resolved by a radiologist. Descriptive statistics characterised anatomical patterns.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Analysis revealed complex venous drainage, with 31.83% (<i>n</i> = 639) demonstrating clinically critical H-type variations (confluencing into horizontal fissure). These were subclassified as HA (30.69%), HO (0.34%), and HAO (0.79%) patterns. V<sup>4</sup>a* traversed the fissure most frequently (29.07%), draining into upper lobe veins (V<sup>3</sup>b, V<sup>3</sup>a, V<sup>2</sup>c), while V<sup>4</sup>b* (2.86%) and V<sup>5</sup>a* (5.50%) exhibited lower traversal rates. No V<sup>5</sup>b* traversed the horizontal fissure. Rare drainage into the inferior pulmonary vein (IPV; V<sup>4</sup>a: 2.59%) or left atrium (0.20%) was observed, and the two-branch venous pattern predominated (42.87%). Previously unreported variants included downward-displaced RS<sup>3</sup> (<i>n</i> = 10) and V<sup>6</sup> → superior pulmonary vein drainage (<i>n</i> = 2). Intraoperative validation confirmed 3D-CTBA classification accuracy.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>This large-scale study establishes the novel HAO classification system for RML venous anatomy, revealing a high prevalence (31.83%) of H-type variations that critically impact RUL safety. Preoperative 3D-CTBA using this framework enables tailored surgical strategies to preserve RML veins traversing the horizontal fissure, reducing injury risks and postoperative complications.</p>\\n </section>\\n </div>\",\"PeriodicalId\":50684,\"journal\":{\"name\":\"Clinical and Experimental Pharmacology and Physiology\",\"volume\":\"52 9\",\"pages\":\"\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-07-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical and Experimental Pharmacology and Physiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/1440-1681.70058\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical and Experimental Pharmacology and Physiology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/1440-1681.70058","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
Anatomical Classification and Clinical Significance of Right Middle Lobe Vein Confluence Variations in Right Upper Lobectomy: A Three-Dimensional Reconstruction Study
Background
Anatomical variations of the right middle lobe (RML) veins pose significant risks during video-assisted thoracoscopic right upper lobectomy (RUL), where unrecognised veins traversing the horizontal fissure may be injured, compromising venous drainage. While 3D reconstruction aids surgical planning, a comprehensive classification system for RML venous confluences was lacking.
Methods
This retrospective cohort study analysed 2007 patients undergoing lung surgery (2017–2023) using preoperative CT-based 3D-CT bronchography and angiography (3D-CTBA; Mimics 21.0). Two thoracic surgeons independently classified RML veins (V4a, V4b, V5a, V5b) by drainage location: horizontal fissure (H-type), anterior mediastinal (A-type), or oblique fissure (O-type). Disagreements were resolved by a radiologist. Descriptive statistics characterised anatomical patterns.
Results
Analysis revealed complex venous drainage, with 31.83% (n = 639) demonstrating clinically critical H-type variations (confluencing into horizontal fissure). These were subclassified as HA (30.69%), HO (0.34%), and HAO (0.79%) patterns. V4a* traversed the fissure most frequently (29.07%), draining into upper lobe veins (V3b, V3a, V2c), while V4b* (2.86%) and V5a* (5.50%) exhibited lower traversal rates. No V5b* traversed the horizontal fissure. Rare drainage into the inferior pulmonary vein (IPV; V4a: 2.59%) or left atrium (0.20%) was observed, and the two-branch venous pattern predominated (42.87%). Previously unreported variants included downward-displaced RS3 (n = 10) and V6 → superior pulmonary vein drainage (n = 2). Intraoperative validation confirmed 3D-CTBA classification accuracy.
Conclusions
This large-scale study establishes the novel HAO classification system for RML venous anatomy, revealing a high prevalence (31.83%) of H-type variations that critically impact RUL safety. Preoperative 3D-CTBA using this framework enables tailored surgical strategies to preserve RML veins traversing the horizontal fissure, reducing injury risks and postoperative complications.
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Clinical and Experimental Pharmacology and Physiology is an international journal founded in 1974 by Mike Rand, Austin Doyle, John Coghlan and Paul Korner. Our focus is new frontiers in physiology and pharmacology, emphasizing the translation of basic research to clinical practice. We publish original articles, invited reviews and our exciting, cutting-edge Frontiers-in-Research series’.
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