Three‐dimensional imaging anatomical research and clinical implications of V1 +2d in the left upper lung

Abstract

AbstractBackgroundTo investigate the distribution pattern of V1+2d in the left superior pulmonary vein and its clinical significance.MethodsA retrospective analysis was conducted using three‐dimensional computed tomographic bronchography and angiography (3D‐CTBA) data from 500 lung cancer patients. Statistical analyses were performed to evaluate the incidence and drainage patterns of the three sub‐branches of V1+2d, namely V1+2d1, V1+2d2 and V1+2d3. Furthermore, clinical data from 10 patients' lesions involving V1+2d were reviewed to illustrate the impact of adjacency to V1+2d on the surgical approach.ResultsThe incidences of V1+2d1, V1+2d2 and V1+2d3 were 100%, 76.4% and 100% respectively. The relative interlobar distribution sizes of B3a and B1+2c and the left upper division (LUD) vein type influenced the incidence of V1+2d2 (p < 0.05; p < 0.001). V1+2d2 predominantly occurred in B3a = B1+2c and B1+2c > B3a patterns. V1+2d2 was entirely absent in the B3a > B1+2c pattern. V1+2d2 exhibited a higher incidence in both the central vein (CV) type and the noncentral vein (NCV) type when compared to the semi‐central vein (SCV) type (100% vs. 100% vs. 64.8%). The most prevalent venous drainage pattern was the three sub‐branches of V1+2d constituting a major trunk to drain (41.2%). All 10 cases with lesions involving V1+2d successfully underwent sublobar resection with no complications, and the surgical margin was ≥2 cm.ConclusionsThe three sub‐branches of V1+2d exhibit a high incidence with diverse distribution patterns, yet a discernible pattern exists. For inter‐ or multi‐intersegmental nodules involving V1+2d, combined segmentectomy and subsegmentectomy or combined subsegmentectomy can ensure the safe margin.