CT引导下带钩钢丝术前定位在胸腔镜下孤立性肺小结节切除术中的应用  

CT-guided hookwire localization of small solitary pulmonary nodules in video-assisted thoracoscopic surgery

作　　者：周建华[1] 李文涛[2] 陈海泉[1] 彭卫军[2] 相加庆[1] 张亚伟[1] 王升平[2] 杨富[1] 周贤 罗晓阳[1] 

机构地区：[1]复旦大学附属肿瘤医院复旦大学上海医学院肿瘤学系胸外科,200032 [2]复旦大学附属肿瘤医院复旦大学上海医学院放射诊断科,200032

出　　处：《中华肿瘤杂志》2009年第7期546-549,共4页Chinese Journal of Oncology

基　　金：上海市科委重大科研项目（06DZ19503）;上海市卫生局局级科研项目（08119）

摘　　要：目的探讨CT引导下带钩钢丝术前定位在胸腔镜下孤立性肺小结节（SSPN）切除术中的临床应用价值。方法对24例患者的26枚SSPN于术前行CT引导下带钩钢丝定位，然后施行电视胸腔镜手术（VATS）楔形切除术。SSPN直径为（10．05±3．08）mm，距壁层胸膜（10．09±2．62）mm。结果CT引导下带钩钢丝定位成功率为100％，定位时间为（20．18±7．16）min。6例（25．0％）患者定位后发生微量气胸，但无需闭式引流处理。VATS楔形切除术成功率为100％。其中8例患者术中冰冻病理诊断为原发性腺癌，均成功施行VATS肺叶切除加淋巴结清扫术。1例食管癌术前检查发现右肺上叶结节的患者，术中冰冻病理诊断为炎性肉芽肿，随后完成VATS食管癌根治术。VATS楔形切除术手术时间为（18．44±6．65）min，术中失血量为（50．35±9．51）ml，术后住院时间为（6．42±3．25）d。术中定位针脱落1例（4．2％），但仍于胸腔镜下观察到穿刺点脏层胸膜下血肿后，准确定位并成功切除。结论CT引导下带钩钢丝术前定位准确率高，相关并发症轻微，是一种安全、有效的方法。定位后行VATS楔形切除术成功率高．值得临床推广应用。Objective Video-assisted thoracoscopic surgery （VATS） provides a minimally invasive approach to resect small solitary pulmonary nodules （SSPN）. The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS. Methods Hookwire was used to localize 26 SSPN under CT guidance in 24 patients （ 14 male, 10 female, age range 21-61 years, mean 52.3 years）, preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated. Results All the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT- guidance. The mean lesion size was 10.05 ± 3.08 mm in diameter, and the mean distance from lesion to parietal pleura was 10.09 ± 2.62 mm. The mean localization time was 20. 18 ± 7. 16 min, and then the nodules were removed by VATS within 18 ± 6.65 min. The major complication of CT-gnided hookwire localization was mild pneumothorax in 6 patients （ 25.0% ） , but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient （4.2%） during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobeetomies were performed. Condusion The preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.

关 键 词：硬币病变 肺 胸外科手术 电视辅助 术前定位 

分 类 号：R686[医药卫生—骨科学]