肺小结节胸腔镜术前CT引导下Hook-wire定位的临床价值  

The Clinic Value of Computed Tomography-guided Localization with a Hook-wire System for Small Pulmonary Nodules before Video-assisted Thoracoscopic Resection

作　　者：王升平[1] 李文涛[1] 彭卫军[1] 陈海泉[2] 何新红[1] 李国栋[1] 王标[1] 胡鸿[2] 罗小阳[2] 沈磊[3] 陈颖[3] 

机构地区：[1]复旦大学附属肿瘤医院放射诊断科,上海200032 [2]复旦大学附属肿瘤医院胸外科,上海200032 [3]复旦大学附属肿瘤医院病理科,上海200032

出　　处：《当代医学》2009年第8期84-86,共3页Contemporary Medicine

摘　　要：目的评价肺小结节胸腔镜术前CT引导下定位的价值。方法2008年2月到2008年5月共8例患者,9个小结节,行胸腔镜切除术,术前皆行CT引导下Hook-wire定位。评价术前CT引导下Hook-wire定位技术的失败率、并发症、胸腔镜手术转为开胸手术的几率、住院时间等。结果共8个患者行9个结节胸腔镜切除术,术前CT引导下Hook-wire定位成功率100%,并发症发生率33%,转化为开胸手术比率为11%,中位住院时间为5天(2天～25天)。SPNs术后组织学诊断结果为:原发性肺癌4例约44.4%,转移4例约44.4%,炎性病灶1例11.1%。结论不具有典型恶性征象的SPNs约50%以上组织学诊断是恶性的,胸腔镜术前CT引导下Hook-wire定位技术极大减少开胸手术的比率、并发症发生率低,并减少住院时间,对于SPNs的鉴别诊断及治疗具有很好的临床价值。Objective To evaluate the value of computed tomography, guided localization with a Hook-wire system for small pul- monary nodules （SPNs） before video-assisted thoracoscopic resection （VATS） in a consecutive series of 8 patients. Methods The records of all patients undergoing VATS resection for SPNs preoperatively localized by CT-guided a hook-wire system from January 2008 to May 2008 were assessed with respect to failure to localize the lesion by the hook-wire system, conversion thoracotomy rate, duration of operation, postoperative complications, and histology of SPNs. Results Eight patients underwent 9 VATS resections, with simultaneous 2 SPNs resection at the same lobe performed in 1. Preoperative CT-guided hook-wire localization successed in all patients （100%）. Conversion thoracotomy was necessary in 1 patients （11%） because it was not possible to resect the lesion by a VATS approach. The average operative time was 53 min. Postoperative complications after localization occurred in 3 patients （33%）, two hemothorax and one pneumonia. The mean hospital stay was 5 days （range： 2-25 days）. Histological assessment revealed inflammatory disease in 1 patients （11. 1%）, metastasis in 4 （44.4%）, non-small-cell lung cancer （NSCLC） in 4 （44.4%）.Conclusion Histological analysis of resected SPNs revealed unexpected malignant disease in more than 50% of the patients indicating that histological clarification of SPNs seems warranted. Video-assisted thoracoscopic resection of SPNs previously localized by a CT-guided hook-wire system is related to a low conversion thoracotomy rate, a short operation time, and few postoperative complications, and it is well suited for the clarification and treatment of SPNs.

关 键 词：肺小结节 CT引导下定位 Hook—wire 胸腔镜切除术 

分 类 号：R655[医药卫生—外科学]