C臂CT在肺小结节胸腔镜切除术前定位中的应用  

The application of C-arm CT in guiding preoperative hook-wire localization of solitary pulmonary nodule before thoracoscopic resection

作　　者：黄大钡[1] 李晓群[1] 张健[1] 文自祥[1] 刘辉来[1] 

机构地区：[1]广东中山市人民医院介入室,528400

出　　处：《介入放射学杂志》2017年第9期843-846,共4页Journal of Interventional Radiology

摘　　要：目的探讨C臂CT在肺小结节胸腔镜术前定位中的应用价值。方法回顾性分析2011年1月至2015年12月51例患者51个孤立性肺结节(SPN)于电视胸腔镜肺叶切除(VATS)术前行C臂CT引导下Hook-wire定位技术,并统计该技术的成功率、定位时间、并发症、VATS转开胸手术率,以及SPN平均大小,距脏层胸膜距离、病理学结果。结果 C臂CT引导下Hook-wire定位成功率100%,平均定位时间16 min,无症状气胸发生率7.8%,无症状出血率21.6%,1例(2.0%)发生脱落,SPN平均大小10.7 mm,距脏层平均距离25.3 mm,穿刺距离(皮肤至肺结节的距离)66.7 mm,恶性SPN占60.8%。结论 C臂CT引导下Hook-wire肺小结节定位准确、安全、快速,是一种高效的引导方式,具有临床应用价值。Objective To discuss the clinical application of C-arm CT in guiding Hook-wire localization of solitary pulmonary nodule （SPN） before video-assisted thoracoscopic surgery （VATS）. Methods The clinical data of 51 patients with SPN （51 lesions in total）, who received C-arm CT-guided Hook-wire localization before VATS during the period from January 2011 to December 2015 at authors＇ hospital, were retrospectively analyzed. The technical success rate, the time spent for localization, the incidence of complications, the rate of VATS conversion to thoracotomy, the average size of SPN, the distance between SPN and visceral pleura, and the pathological findings were documented. Results The technical success rate of preoperative C-arm CT-guided Hook-wire localization was 100%. The mean time spent for localization was 16 minutes. Asymptomatic pneumothorax occurred in 4 patients （7.8%） and asymptomatic hemorrhage in I 1 patients （21.6%）. Intraoperative dislodgement of the hook-wire was seen in one patient （2.0%）. The average size of SPN was 10.7 ram. The mean distance between SPN and visceral pleura was 25.3 mm, and the puncturing depth （the length from skin to pulmonary nodule） was 66.7 mm. Pathological examination revealed that 60.8% of the 51 SPNs were malignant. Conclusion Preoperative C-arm CT-guided Hook-wire localization of SPN before VATS is an accurate, safe and fast technique. This technique is an efficient means to guide the puncturing, and it has high application value in clinical practice. （J Intervent Radiol, 2017, 26： 843-846）

关 键 词：C臂CT 肺结节 Hook—wire 电视辅助胸腔镜手术 

分 类 号：R655.3[医药卫生—外科学] R816.4[医药卫生—临床医学]