CT引导下弹簧圈定位结合DSA实时导向VATS精准切除孤立性肺结节的诊疗价值  

Diagnostic and treatment value of CT-guided coil localization followed by real-time DSA-guided accurate resection of solitary pulmonary nodules with video-assisted thracoscopic surgery

作　　者：强勇[1] 杨楠[1] 许建[2] 熊磊[1] 易俊[1] 钱建军[1] 罗立国[1] 董国华[1] 申翼[1] 李德闽[1] 李忠东[1] 

机构地区：[1]南京军区南京总医院心胸外科,南京医学硕士210002 [2]南京军区南京总医院医学影像科,南京210002

出　　处：《医学研究生学报》2015年第2期153-156,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81172032)

摘　　要：目的肺部结节在手术中的定位一直是临床中的难题。文中讨论CT引导下弹簧圈定位结合数字减影血管造影术(digital subtraction angiography,DSA)实时导向电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)精准切除孤立性肺结节(solitary pulmonary nodule,SPN)的诊疗价值。方法收集2011年9月至2014年5月间南京军区南京总医院心胸外科收治的SPN患者82例。患者均于手术当天在CT引导下经皮穿刺,紧贴病灶放置金属弹簧圈定位,随后送入杂交手术室。术中结合DSA实时导向行VATS楔形切除SPN,再根据术中快速病理结果行下一步处理。结果金属弹簧圈定位成功率100%,平均定位时间(15.3±3.2)min,VATS楔形平均切除手术时间(24.2±12.1)min,术后病理结果显示恶性病变45例、良性病变37例,无严重并发症。结论 SPN在术前CT引导下置入弹簧圈标记定位准确率高。结合DSA实时导向行VATS切除可精准切除病灶,并确保切缘距离病灶2 cm以上,达到SPN诊治一体化的目的。Objective The localization of pulmonary nodules in surgery remains a clinical challenge. In this study we discussed the diagnostic and treatment value of CT-guided coil localization followed by real-time digital subtraction angiography（ DSA）-guided accurate resection of solitary pulmonary nodules（ SPN） with video-assisted thracoscopic surgery（ VATS）. Methods This study involved 82 cases of SPN treated in the Department of Cardiothoracic Surgery of Jinling Hospital from September 2011 to May2014. The SPNs were preoperatively positioned by placing a metal coil close to the lesion under CT guidance on the same day of surgery. Then VATS wedge resection of the SPNs was performed under the guidance of real-time DSA and further procedures followed in accordance with the results of intraoperative pathology. Results The success rate of coil localization was 100%,the mean time of positioning was（ 15. 3 ± 3. 2） min,and the mean time of VATS wedge resection was（ 24. 2 ± 12. 1） min. Pathological results revealed45 cases of malignancy and 37 cases of benign lesions. Conclusion Preoperative CT-guided coil localization of SPNs showed a high accuracy and no serious complications,and by real-time DSA-guided VATS that immediately followed,the nodules could be precisely removed with the cutting edge 2 cm above the lesion,which achieved both the purposes of diagnosis and treatment of SPNs.

关 键 词：孤立性肺结节 DSA实时导向 电视胸腔镜手术 血管栓塞弹簧圈 

分 类 号：R81[医药卫生—放射医学]