CT引导下Hook-wire定位对胸腔镜下肺结节治疗的应用及并发症分析  

Application of CT-guided Hook-wire localization in video-assisted thoracoscopic surgery for pulmonary nodules

作　　者：顾勤花[1] 沈琦斌[1] 李鸿伟[1] 黄小燕[2] 李冬[1] 谢忠海[1] 闵伟伟 GU Qinhua;SHEN Qibin;LI Hongwei;HUANG Xiaoyan;LI Dong;XIE Zhonghai;MIN Weiwei(Department of Cardiothoracic Surgery,Huzhou Central Hospital,Huzhou 313000,China)

机构地区：[1]湖州市中心医院(湖州师范学院附属中心医院)心胸外科,313000 [2]湖州市中心医院(湖州师范学院附属中心医院)放射科,313000

出　　处：《浙江医学》2020年第14期1469-1472,共4页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2018RC071)。

摘　　要：目的探讨CT引导下Hook-wire定位对胸腔镜下肺单、多发结节治疗的临床应用价值及并发症发生的影响因素。方法回顾性分析2015年2月至2019年2月湖州市中心医院收治的177例患者236枚结节在电视胸腔镜手术(VATS)切除术前行CT引导下Hook-wire定位的临床和影像学资料,统计分析定位成功率、病理检查结果、并发症发生及其影响因素。结果236枚肺结节CT引导下定位成功率96.61%,定位时间(12.6±8.3)min,定位深度(25.43±8.23)mm,无中转开胸,VATS手术成功率100%。术后病理检查显示,恶性结节166枚(70.34%),良性结节70枚(29.66%)。定位后发生少量气胸32例(18.08%),少量血胸23例(12.99%),合并无症状气血胸患者14例(7.91%),脱钩者8例(4.52%),并发症总发生率为43.50%。多发结节患者的并发症发生率显著高于单发结节患者(P<0.05)。多因素logistic回归分析显示,肺部疾病史、进针角度、定位时间均是Hook-wire定位并发症的独立危险因素(均P<0.05)。结论Hook-wire定位是一种安全、有效、并发症轻微的VATS术前定位方法,采取适当的干预措施,对肺多发结节的定位也具有较高的可行性和有效性。Objective To investigate the clinical application of CT-guided Hook-wire localization in video-assisted thoracoscopic surgery(VATS)for pulmonary nodules and its influencing factors.Methods A total of 177 patients with 236 pulmonary nodules in Huzhou Central H ospital from February 2015 to February 2019 undergoing CT guided Hook-wire localization before VATS were enrolled in the study.The localization achievement rate,pathologic results,complication rate and risk factors of complications were assessed.Results The localization achievement rate of CT guided Hook-wire localization in 236 lung nodules was 96.6%,and the average localization time and depth of single nodule was(12.6±8.3)min and(25.43±8.23)mm,respectively.The postoperative pathology revealed that 166 lung nodules were malignant and 70 were benign.The overall incidence rate of postoperative complications was 43.50%(77/177),with 32 cases of pneumothorax(18.08%),23 cases of pulmonary hemorrhage(12.99%),14 cases of asymptomatic pneumothorax combined with hemothorax(7.91%)and 8 cases of decoupling(4.52%).The incidence of complications in patients with multiple nodules was significantly higher than that in patients with single nodules(P<0.05).Logistic regression analysis showed that disease history,needle insertion angle and puncture time were independent risk factors associated with complications of Hook-wire localization(all P<0.05).Conclusion CT-guided Hook-wire localization is a safe,effective method for VATS of pulmonary nodules with low complication rate.

关 键 词：Hook-wire定位 肺多发结节 电视胸腔镜手术 并发症 LOGISTIC回归 

分 类 号：R816.41[医药卫生—放射医学] R655.3[医药卫生—临床医学]