肺结节术中体表定位在胸腔镜手术中的应用研究  

A research on the application of body surface localization in the treatment of pulmonary nodules during thoracic surgery

作　　者：张斌杰[1] 张永奎[1] 乐涵波[1] 陈志军[1] 陈城[1] 李武军[1] 

机构地区：[1]浙江省舟山医院,浙江大学舟山医院胸心外科,浙江舟山316000

出　　处：《中国癌症杂志》2017年第12期976-979,共4页China Oncology

基　　金：浙江省舟山市科技局资助项目(2015C31031)

摘　　要：背景与目的:关于肺结节手术的定位,目前报道较多的是在CT引导下的术前定位。我们通过研究,探讨一种更简便、安全、可靠的肺结节定位法,为需行胸腔镜下肺部分切除的肺结节患者提供精确的定位。方法:56例肺小结节患者通过术前CT上测量肺小结节在胸壁体表可以定位的位置,进而行胸腔镜下肺部分切除。术中麻醉成功摆置体位后,作好标记,消毒、铺巾后,于术前定位点用静脉套管针刺入,嘱麻醉师膨肺,用电凝烧灼套管针金属内芯外端,使肺表面留下电灼定位点,胸腔镜下根据电凝烧灼点,确定结节的位置。统计定位准确率、并发症发生率。结果:统计该胸壁体表定位法肺小结节定位点与结节的距离,结果准确定位的成功率为94.6%。其中3例患者术中发现小结节与定位点出现较大偏差(大于1.5 cm),有2例出现穿刺点活动性出血(发生率为3.6%),无其他并发症。结论:术中即时的肺结节体表定位法,区别于其他术前定位方法(如Hook-wire),该方法可以避免患者长时间暴露在放射线的辐射中,并减少患者疼痛及心理负担,减少术前定位环节。术中即时操作,并可避免其他有创定位法的各种并发症。是一种简便、安全、经济、精准的胸腔镜肺结节术前定位的好方法。Background and purpose： At present, the published articles have indicated that pulmonary nodule surgery positioning is mainly focused on the CT-guided preoperative localization. This study aimed to explore a simpler, safe and reliable method of lung nodule localization, in order to provide precise positioning of pulmonary nodules for thoracoscopic lung resection. Methods： Fifty-six patients with small pulmonary nodules received CT scanning to find the position of the small nodules on the chest wall before partial lung resection. Venous catheter was used in the preoperative location points. We exhorted the anesthesiologist to do the lung inflation. The positioning point of the lung surface was left using the electric coagulation for the metal inner core of casing needle. The location of the nodule was confirmed by the electric coagulation and burning point. We counted location accuracy rate, complication rate, video-assisted thoracic surgery （VATS） success rate of pulmonary resection. Results： The data of the distance between pulmonary nodules anchor point and nodules of the surface location method on the chest wall were collected. Finally, the operation success rate was 94.6%. The small nodules in 3 cases were found to have a significant deviation （〉1.5 cm） from the positioning points. There were 2 cases with active bleeding （3.6%）, no other complications occurred. Conclusion： In contrast to other preoperative localization methods （such as hookwire）, intraoperative localization of lung nodules on the body surface during operation can protect patients from prolonged exposure to radiation, reduce pain and psychological burden of patients, reduce the steps of preoperative localization, lntraoperative immediate operation could avoid other complications of invasive location method. It is a simple, safe, economical and accurate method for the preoperative localization of pulmonary nodules.

关 键 词：肺小结节 体表定位 胸腔镜 

分 类 号：R734.2[医药卫生—肿瘤]