C臂CT在肺孤立性结节胸腔镜切除术术前定位中的应用  

The clinical application of C-arm CT scanning in localizing solitary pulmonary nodule before video-assisted thoracoscopic resection

作　　者：张高尚[1] 李晓群[1] 张健[1] 黄大钡[1] 李记华[1] 张勇[1] 文自祥[1] 刘辉来[1] 

机构地区：[1]广东省中山市人民医院,528403

出　　处：《介入放射学杂志》2012年第10期829-832,共4页Journal of Interventional Radiology

摘　　要：目的评价肺内孤立性结节胸腔镜术前c臂CT引导下定位的可行性、安全性和临床价值。方法19例共19个孤立性结节性病灶，术前皆行C臂CT引导下Hook-wire定位。根据手术结果．评价术前c臂CT引导下Hook-wire定位技术的成功率、并发症发生率、胸腔镜手术转为开胸手术的概率。结果19例患者19个结节行胸腔镜切除术，术前c臂cT引导下Hook-wire定位成功率94．7％（18／19）；无症状气胸发生率10．5％（2／19），均无需闭式引流治疗，无咯血、血胸等并发症。胸腔镜手术时间平均（154-8．5）min；无中转开胸病例；住院时间8—27d，平均14d。肺内孤立性结节性病灶术后组织学诊断结果为支气管肺泡癌5例，腺癌3例，平滑肌肉瘤1例，非恶性结节8例。结论胸腔镜术前C臂CT引导Hook—wire定位肺内孤立性结节病灶，快速、安全、有效，特别在直径≤10mm的肺微小结节的定位中具有较高的临床价值。Objective To evaluate the feasibility, safety and clinical application of C arm CT scanning in localizing solitary pulmonary nodule before video assisted thoracoscopic resection （VATS）. Methods A total of 19 patients with solitary pulmonary nodule were enrolled in this study. The sum total of the lesions was 19. Preoperative C arm CT guided hook wire localization of the pulmonary lesion was performed in all patients. Based on the VATS resection results, the success rate of localization with Carm CT guided hook wire system was evaluated. The occurrence of complications and the probability of thoracotomy were analyzed. Results VATS resection was carried out for all 19 lesions in the 19 patients. The preoperative successful localization with C arm CT guided hook wire system was 94.7% （18/19）. Asymptomatic pneumothorax was seen in two patients （10.5%）, and no special treatment was needed. Neither hemoptysis nor hemothorax occurred. The average videoassisted thoracoscopy time was （15 ＋ 8.5） min. No thoracotomy was needed in all patients. The mean hospitalization days of the patients ranged from 8 to 27 days with an average of 14 days. Histological examination revealed that the lesions included alveolar cell carcinoma （n = 5）, adenocarcinoma（n = 3）, leiomyosarcoma （n = 1） and nonmalignant nodules （n = 8）. Conclusion For localizing solitary pulmonary nodule before video assisted thoracoscopic resection, C arm CT guided hookwire system localization is a safe, effective and quicklyaccomplished technique, which is especially useful for the diagnosis of the small pulmonary nodules with the diameter ≤10 ram. （J Intervent Radiol, 2012, 21： 829832）

关 键 词：结节性病变 肺 C臂CT 胸腔镜检查 

分 类 号：R816.41[医药卫生—放射医学]