孤立性肺结节胸腔镜术前三维CT引导下钩丝定位的价值  

The incremental value of three-dimensional computed tomography-guided localization with Hook-wire for solitary pulmonary nodule before thoracoscopic surgery

作　　者：董科[1] 陈献国[2] 唐志苗[2] 石洪成[3] 刘江[1] 应明亮[1] 刘情[1] 

机构地区：[1]浙江省金华市中心医院影像科,浙江金华321000 [2]浙江省金华市中心医院胸外科,浙江金华321000 [3]上海复旦大学附属中山医院影像科,上海200032

出　　处：《医学影像学杂志》2012年第11期1858-1861,共4页Journal of Medical Imaging

摘　　要：目的探讨孤立性肺结节术前三维CT引导下钩丝定位技术对胸腔镜手术的增益价值。方法收集行胸腔镜手术切除孤立性肺结节患者共92例,其中术前行三维CT引导下钩丝定位者37例,未行定位者55例。回顾性分析术前钩丝定位对胸腔镜转为开胸手术的几率、平均手术时间、平均住院时间的影响,并对其差异进行统计学分析。结果术前三维CT引导下钩丝定位成功率100.0%,定位操作时间平均(11.5±7.2)min,并发气胸及出血发生率为56.8%(21/37)。钩丝定位后胸腔镜转为开胸手术的几率为5.4%(2/37),平均手术时间为(21.7±8.0)min,平均住院时间为(9.5±3.5)天。未定位直接行胸镜手术,转为开胸手术的几率为29.1%(16/55)、平均手术时间(45.9±10.4)min,平均住院时间为(14.1±4.5)天。分别进行2检验和t检验,P<0.05,差异有统计学意义。结论术前三维CT引导下钩丝定位技术安全、准确,降低了转为开胸手术的几率,缩短了胸腔镜的手术时间和住院时间,对于孤立性肺结节胸腔镜手术具有很好的增益价值。Objective To evaluate the incremental value of three-dimensional computed tomography-guided localization with Hook-wire for solitarypulmonary nodule （SPN） before video-assisted thoracoscopic surgery （VATS）. Methods From Jan 2003 to Dec 2011, 92 patients underwent thoracoscopic pulmonary resection, of which 37 patients with SPN were preoperatively localized by CT-guided Hook- wire, other 55 patients without being localized using CT-guided Hook- wire. The onversion rate of open thoracotomy, average duration of operation and average hospitalization time were retro- spectively compared between two groups, t -test and X2 test were used. Results Preoperative CT-guided Hook-wire locali- zation was successful in all patients （100.0%）. The average localization time was （11.5±7.2） min. The occurrence rate of pneumothorax and hemothorax was 56.8% （21/37）. In two group with and without Hook-wire localized, the conversion rate of open oracotomy, average duration of operation and average hospitalization time were 5.4 % （2/37）, （21.7 ±8. 0） min, （9.5±3.5） d and 29.1%（16/55）, （45.9±10.4） min, （14.1±4.5） d, respectively. There were statistically signif- icant different between with and without Hook-wire localized groups （ P 〈0.05）. Conclusion Preoperative CT-guided Hook-wire localization is suitable, safe and effective for VATS resection of SPN. It is related to a low alteration thoracoto- my rate, short operation time and hospitalization time, and it has incremental value for the VATS resection of SPN.

关 键 词：孤立性肺结节 胸腔镜 体层摄影术 X线计算机 立体定位技术 带钢丝牵引钩 

分 类 号：R563[医药卫生—呼吸系统] R814.42[医药卫生—内科学]