肺小结节胸腔镜切除术前CT引导下带钩金属导丝锚定  

Thoracoscopic resection preoperative localization of small pulmonary lesions with CT-guided short hook wire

作　　者：张晓燕[1,2] 高顺禹[1,2] 陈克能[1,3] 汪宁[1,2] 齐丽萍[1,2] 崔湧[1,2] 唐磊[1,2] 陈麦林[1,2] 单军[1,2] 李晓婷[1,2] 孙应实[1,2] 

机构地区：[1]北京大学肿瘤医院 [2]北京市肿瘤防治研究所医学影像科,北京100142 [3]北京市肿瘤防治研究所胸部肿瘤外一科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中国医学影像技术》2015年第4期558-562,共5页Chinese Journal of Medical Imaging Technology

基　　金：国家重点基础研究发展计划(973计划)项目(2011CB707705);国家自然科学基金(81371715);北京市科学技术委员会:首都特色临床应用研究(Z121107001012115)

摘　　要：目的探讨肺小结节胸腔镜切除术前CT引导下带钩金属导丝锚定操作方法及其临床应用价值。方法对28例恶性肿瘤患者共30枚肺小结节行CT引导下带钩金属导丝锚定辅助胸腔镜切除,评估结节定位的成功率、手术时间、并发症,分析其对患者肿瘤分期及疗效评价的影响。结果术前CT引导下带钩金属导丝定位平均手术时间为(15.0±3.2)min。28例患者(共30枚)肺小结节中,1例(1枚)患者术中见定位针脱落,行肺叶切除;另27例(29枚)结节均准确定位并行楔形肺切除。定位术后7例(7/28,25.00%)患者发生少量气胸,针道周围少量出血8例(8/27,29.63%),其中3例(3/28,10.71%)患者同时出现少量气胸和针道周围少量出血。术后病理证实15例(15/28,53.57%)肿瘤复发转移,1例(1/28,3.57%)患者为第二原发癌,12例(12/28,42.86%)患者因确诊为肺内良性结节确定肿瘤分期不变或疗效稳定。结论肺小结节胸腔镜切除术前CT引导下带钩金属导丝锚定操作便捷,成功率高,并发症少,对患者肿瘤准确分期及疗效评价有重要意义。Objective To explore the methods of thoracoscopic resection preoperative localization of small pulmonary lesions with CT-guided short hook wire and the value for tumor staging and evaluating treatment efficacy.Methods Percutaneous wire hook anchor localization of 30 nodules was performed with CT guidance in 28 patients of malignant tumors.The success rate of location,operation time,complications were counted.And effects of thoracoscopic resection of pulmonary nodules on malignant tumor staging and treatment evaluation were analyzed.Results The mean operation time was（15.0±3.2）min.In all 28patients（30nodules）,the hook wire was found dislodgment in 1case（1nodule）,who underwent lobectomy.And the other 27cases（29nodules）were successfully located by the wire hook anchors,who were performed with pulmonary wedge resections successfully.Nonsymptomatic pneumothorax was observed in 7cases（7/28,25.00%）,mild hemorrhage around the wire was observed in 8cases（8/27,29.63%）,both of them were observed in 3cases（3/28,10.71%）.According to the pathology results,53.57%（15/28）of patients were confirmed tumor recurrence and metastasis,3.57%（1/28）of patients was a second primary cancer.Totally 42.86%（12/28）of malignant patients＇ tumor stages were unchanged or the treatment effects were stable for benign pathology results.Conclusion Percutaneous CT guided wire hook anchor localization for small lung nodules pre-thoracoscopic resection is an easily operated and safe operation with high success rate,which has fewer complications and less trauma to the patients.It is very useful for tumor staging and evaluating treatment efficacy.

关 键 词：肺结节 电视辅助胸腔镜手术 微创 术前定位 体层摄影术 X线计算机 

分 类 号：R814.42[医药卫生—影像医学与核医学] R734.2[医药卫生—放射医学]