术前CT定位在电视胸腔镜手术治疗肺部小结节中的应用  

Preoperative CT-guided localization and intraoperative dyestuff-clip marking in video-assisted thoracoscopic pulmonary nodule excision

作　　者：叶俊[1] 杨劼[1] 古卫权[1] 杨胜利[1] 王飞[1] 肖叶[1] 张小文[1] 罗灵均 赵宁 吴玲玲 陈迪耀[1] YE Jun;YANG Jie;GU Weiquan;YANG Sengli;WANG Fei;XIAO Ye;ZHANG Xiaowen;LUO Lingjun;ZHAO Ning;WU Lingling;CHEN Diyao(Department of Thoracic Surgery,Foshan Hospital of Sun Yat-sen University/the First People′s Hospital of Foshan,Foshan,Guangdong 528000,China)

机构地区：[1]佛山市第一人民医院胸外科,广东佛山528000

出　　处：《岭南现代临床外科》2018年第6期671-674,共4页Lingnan Modern Clinics in Surgery

基　　金：佛山市科技局医学类科技攻关项目(2015AB00312)

摘　　要：目的探讨术前CT定位、术中染料结扎夹标记肺结节表面胸膜的方法在电视胸腔镜下肺小结节切除术中的应用价值。方法选取2015年8月至2018年5月在本院胸外科治疗的89例患者,98枚肺小结节,术前CT在体表定位肺部小结节,术中在胸腔镜辅助下,以亚甲蓝结扎夹标记肺结节表面胸膜,完成镜下楔形切除术。结果 98枚结节按此方法成功定位85枚(87%),13枚结节因其位于纵隔面无法按此方法完成定位,术中无并发症发生,定位成功后行VATS肺楔形切除术,无中转开胸手术,术中均取得明确病理诊断。结论术前CT定位,染料结扎夹标记肺结节表面胸膜的定位方法,简单有效,准确率高,安全性好,是肺部小结节微创术前理想的定位方法。Objective To investigate the value of preoperative CT-guided localization and intraoperative dyestuff-clip marking in VATS pulmonary nodule excision. Methods A total of 89 patients from August 2015 to May 2018 were registered,who received treatment in the department of thoracic surgery of The First People′s Hospital of Foshan. There were 98 pulmonary nodules used CT guiding localization before operation,and used the methylene blueclip marking the pleural surface of pulmonary nodules during the operation. Then we performed the vedio-assist thoracoscopic wedge resection. Results Of the 98 nodules,85 cases(87%)were were successfully localized. The other 13 cases failed to locate because of their proximity to the mediastinal surface. All the 85 cases received vedio-assist thoracoscopic wedge resection successfully. There were no severe complications occurred during the operation,and no one transfered to open thoracotomy. All patients were histologically confirmed during the operation.Conclusion VATS by CT-guided localization before operation and dyestuff-clip marking intraoperatively is a viable safe procedure that meets oncological criteria for lung nodules surgery. In our experience,VATS is currently to be considered ideally indicated for pulmonary nodule surgery.

关 键 词：肺结节 亚甲蓝 术前定位 电视胸腔镜手术 

分 类 号：R655.3[医药卫生—外科学]