CT引导美蓝染色在肺磨玻璃样微小结节术前精确定位中的应用  

The application of accurate preoperative CT-guided methylene-blue labeling in pulmonary small ground glass opacity

作　　者：唐朗[1] 郝志鹏[1] 付圣灵[1] 蔡奕欣[1] 张霓[1] 付向宁[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院胸外科

出　　处：《临床外科杂志》2015年第12期928-930,共3页Journal of Clinical Surgery

摘　　要：目的探讨cT引导美蓝染色定位法在肺磨玻璃样微小结节（small ground glass opacity，sGGO）术前精确定位中的临床应用及效果。方法肺磨玻璃样微小结节患者79例，均于术前行CT引导美蓝染色定位后，然后采取电视辅助胸腔镜手术（video assisted thoracic surgery，VATS）肺楔形切除，根据术中快速冰冻切片病理结果决定下一步手术方式。评估美蓝染色定位准确率、并发症发生率、定位后至VATS平均间隔时间、中转开胸率、术后平均住院时间以及术后病理分型。结果美蓝染色定位准确率为100．0％，出现大咯血1例（1．2％），少量气胸13例（16．0％），胸膜反应2例（2．5％），定位后至VATS平均间隔时间为（62．5±15．3）分钟，中转开胸2例，术后平均住院时间（7．0±1．5）天。术后病理检查结果为原发性肺癌51例，良性病变27例，未发现病灶1例。结论CT引导美蓝染色定位应用于肺磨玻璃样微小结节的术前定位，能够准确显示病变区域。Objective To discuss the value of CT-guided methylene-blue labeling before thoracoscopic resection of pulmonary small ground glass opacity （sGGO）. Methods A total of 79 sGGOs patients were enrolled. After CT-guided methylene-blue labeling, video-assisted thoracic surgery （VATS） was immediately adopted for pulmonary wedge resection. According to the result of intraoperative frozen pathology, the next treatment method would be decided. The evaluation include labeling accuracy, complications, the mean duration between labeling to VATS, transfer rate in the chest, the mean time of postoperative hospital stays and sGGO pathological classification. Results The success rate of methylene-blue labeling was 100%. There were 1 case of hemoptysis（ 1.2% ）, 13 cases of mild pneumothorax（ 16.0% ）, and 2 cases of pleural reaction （ 2.5 % ）. The mean duration between labeling to VATS was （62.5 ± 15.3） min. Conver- sion to the thoracotomy was carried out in 2 patients. The mean time of postoperative hospital stays was （7. 0 ±1.5） d. The sGGO postoperative histological pathology results showed 51 cases of primary lung cancer, 27 cases of benign lesions, and 1 case without lesion. Conclusion The method of preoperative CT-guided methylene-blue labeling of sGGO can accurately reveal the lesions.

关 键 词：肺磨玻璃样微小结节 美蓝染色 电视辅助胸腔镜 

分 类 号：R734.2[医药卫生—肿瘤]