螺旋CT四维重建对早期肺小结节术前定位的价值  

VALUE OF SPIRAL CT FOUR-DIMENSIONAL RECONSTRUCTION IN PREOPERATIVE LOCALIZATION OF EARLY PULMONARY NODULES

作　　者：谢锐文[1] 周建平[1] 袁焕初[1] 袁金权[1] XIE Ruiwen;ZHOU Jianping;YUAN Huanchu;YUAN Jinquan(Department of Cardiothoracic Sur- gery,Dongguan People’s Hospital,Dongguan 523000,China)

机构地区：[1]东莞市人民医院心胸外科

出　　处：《青岛大学学报（医学版）》2019年第5期568-571,共4页Journal of Qingdao University(Medical Sciences)

基　　金：东莞市科技计划项目(201310515000290)

摘　　要：目的 探讨256排螺旋CT四维重建技术在早期肺小结节术前定位中的应用效果。方法 收集2014年9月1日—2017年3月1日在我院行胸腔镜切除术的肺小结节病人46例,按照不同的定位方法分为两组。试验组18例病人术前采用256排螺旋CT四维重建技术确定肺小结节所在肺段,定位后直接行胸腔镜解剖性肺段切除手术;对照组28例病人术前采用低剂量CT引导下穿刺定位,定位后行胸腔镜楔形切除手术。分别记录两组病人的定位成功率、穿刺并发症、切缘阳性率、术中出血量和住院时间。结果 试验组病人的定位成功率(100.0%)明显高于对照组78.6%(χ^2=4.44,P<0.05)。试验组病人无因切缘阳性而需二次手术切除者,而对照组有2例因术中冷冻病理检查提示切缘阳性而需要再次手术扩大切除范围。对照组和试验组病人的总并发症发生率分别为42.9%和0,试验组明显低于对照组(χ^2=10.44,P<0.05)。试验组病人术中出血量和住院时间均低于对照组病人,但两组之间差异无显著性(P>0.05)。结论 256排螺旋CT四维重建术前能立体定位肺小结节,更准确判定病灶情况,有利于术中精准完整切除病灶,并可避免术前穿刺操作,减少相应并发症发生,值得基层医院推广应用。Objective To investigate the application effect of 256-slice spiral CT four-dimensional reconstruction in preoperative localization of early pulmonary nodules. Methods A retrospective analysis was performed for the clinical data of 46 patients with pulmonary nodules who underwent thoracoscopic resection in our hospital from September 1, 2014 to March 1, 2017. According to the localization method, the patients were divided into experimental group with 18 patients and control group with 28 patients. For the patients in the experimental group, 256-slice spiral CT four-dimensional reconstruction was performed before surgery to identify the lung segments with pulmonary nodules, and thoracoscopic pulmonary segmental resection was performed after localization;for the patients in the control group, low-dose CT-guided puncture was performed for preoperative localization, and thoracoscopic wedge resection was performed after localization. The two groups were compared in terms of success rate of localization, puncture complications, positive rate of resection margin, intraoperative blood loss, and length of hospital stay. Results The experimental group had a significantly higher success rate of localization than the control group (100.0% vs 78.6%,χ^2=4.44, P <0.05). No patient in the experimental group underwent a second surgery due to positive surgical margin, while 2 patients in the control group underwent a second surgery with extended resection due to positive surgical margin suggested by intraoperative frozen pathological examination. The experimental group had a significantly lower incidence rate of total complications than the control group (0 vs 42.9%,χ^2=10.44, P <0.05). The experimental group had less intraoperative blood loss and a shorter length of hospital stay than the control group ( P >0.05). Conclusion The 256-slice spiral CT four-dimensional reconstruction can be used to locate pulmonary nodules before surgery and can accurately evaluate the conditions of the lesions. It also helps with the precise and c

关 键 词：孤立性肺结节 四维计算机体层摄影术 立体定位技术 肺切除术 

分 类 号：R445.3[医药卫生—影像医学与核医学] R521.6[医药卫生—诊断学]