硬化剂定位联合单操作孔胸腔镜切除肺部微小结节的临床应用价值  

Localization of small pulmonary ground glass opacity before single-port video-assisted thoracoscopic resection: Value of CT-guided injection of sclerosing agents

作　　者：王柏霖 林吉兴 申磊磊 徐恒亮 王波[1] 李家开[2] 梁朝阳[1] WANG Bailin;LIN Jixing;SHEN Leilei;XU Hengliang;WANG Bo;LI Jiakai;LIANG Chaoyang(Department of Thoracic Surgery;Department of Radiology Hainan Branch of Chinese PLA General Hospital, Sanya 572000, Hainan Province, China)

机构地区：[1]解放军总医院海南分院胸外科,海南三亚572000 [2]解放军总医院海南分院放射科,海南三亚572000

出　　处：《解放军医学院学报》2018年第5期419-421,共3页Academic Journal of Chinese PLA Medical School

基　　金：海南省社会发展基金项目(SQ2015SHFZ0010)~~

摘　　要：目的探讨CT引导下经皮穿刺肺组织注射硬化剂定位联合单操作孔胸腔镜切除肺部微小结节的可行性与安全性。方法回顾性总结我院2016年6月-2017年11月收治的16例肺部微小磨玻璃密度结节患者(含20个病灶),术日先在局麻下行CT引导下经皮穿刺肺组织注射硬化剂于肺部微小结节旁定位,然后在全麻下行单操作孔胸腔镜病灶切除,根据快速病理检查结果行局部切除、解剖性肺段切除或肺叶切除术。评估定位的准确性、手术切除方式及并发症等。结果 CT显示20个肺部微小磨玻璃密度结节均位于胸膜下,胸膜无改变,结节平均直径(8.44±6.55)mm,病灶边缘距胸膜距离(8.19±2.72)mm。19个结节经CT引导硬化剂注射定位后,在术中可触及,定位准确率95%。因注射出血致硬化剂移位、定位失败1例。穿刺定位平均时间(18.55±8.33)min,手术切除病灶平均时间(15.31±4.35)min。手术方式包括楔形切除13例、肺段切除4例和肺叶切除3例,术后均无并发症。术后病理为浸润性腺癌4例,微浸润性腺癌5例,原位癌3例,不典型增生5例,纤维增生炎症3例。结论 CT引导下经皮穿刺肺组织注射硬化剂注射定位联合单操作孔胸腔镜切除肺部微小结节是一种安全、可行的方法。Objective To explore the feasibility and safety of CT-guided localization with injection of sclerosing agents and singleport video-assisted thoracoscopic resection of small pulmonary ground glass opacity. Methods Clinical data about 16 patients（20 nodules） with small pulmonary ground glass opacity in our department from June 2016 to October 2017 were retrospectively analyzed. CT-guided localization with injection of sclerosing agents was performed via percutaneous puncture of lung tissue under local anesthesia, and then single-port video-assisted thoracoscopic resection of pulmonary focuses was carried out under general anesthesia. According to the rapid pathological examination results, local excision, anatomic segmentectomy or lobectomy was performed. The accuracy of localization, surgical strategies, and complications were evaluated in this study. Results Twenty small pulmonary ground glass opacity focuses were all located at sub-pleural（CT scan）, and no change was observed in the pleural. The average diameter of the nodules was（8.44±6.55） mm, and the distance from the edge of the lesion to the pleural was（8.19±2.72） mm.Nineteen nodules that were located by CT guided percutaneous injection of sclerosing agents could be touched during operation with the accuracy rate of localization of 95%. Failure of localization occurred in one case due to displacement resulted from hemorrhage. The average time of puncture and location was（18.55±8.33） min and the average time of surgical excision was（15.31±4.35） min,including 13 cases of wedge excision, 4 cases of segmental resection of lung and 3 cases of lobectomy. No complication was observed after operation. The postoperative pathology showed that 4 cases were invasive adenocarcinoma, 5 cases were minimally invasive adenocarcinoma（MIA）, 3 cases were adenocarcinoma in situ, 5 cases were atypical hyperplasia（AAH）, and 3 cases were fibrous hyperplasia and inflammation. Conclusion It is a safe and accurate way to treat small pulmonary groun

关 键 词：肺磨玻璃结节 CT术前定位 单操作孔胸腔镜 

分 类 号：R655.3[医药卫生—外科学]