术中超声辅助电视胸腔镜手术治疗孤立性肺小结节的应用研究  

The application of intraoperative ultrasound in the treatment of small solitary pulmonary nodule by video-assisted thoracic surgery

作　　者：王彦冬[1] 侯跃龙[2] 经翔[1] 韩洪利[2] 丁建民[1] 张翔[3] 张勤[4] Wang Yandong;Hou Yuelong;Jing Xiang;Han Hongli;Ding Jianmin;Zhang Xiang;Zhang Qin(Department of Ultrasound,Tianjin Third Central Hospital,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Artificial Cell Engineering Technology Research Center,Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China;Department of Thoracic Surgery,Tianjin Third Central Hospital,Tianjin 300170,China;Department of Radiology,Tianjin Third Central Hospital,Tianjin 300170,China;Department of Pathology,Tianjin Third Central Hospital,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院超声科天津市重症疾病体外生命支持重点实验室天津市人工细胞工程技术研究中心天津市肝胆疾病研究所,300170 [2]天津市第三中心医院胸外科,300170 [3]天津市第三中心医院放射科,300170 [4]天津市第三中心医院病理科,300170

出　　处：《中华超声影像学杂志》2020年第10期864-869,共6页Chinese Journal of Ultrasonography

摘　　要：目的探讨术中超声(intraoperative ultrasound,IOUS)辅助电视胸腔镜手术(video-assisted thoracic surgery,VATS)在孤立性肺小结节(small solitary pulmonary nodule,SSPN)诊治中的应用价值。方法选取2016年1月至2020年1月天津市第三中心医院35例因SSPN行VATS的患者,术中分别应用传统视诊联合触诊法(visual and touch examination,VTE)及IOUS法定位肺结节,比较两种方法在定位成功率、定位时间之间的差异。对SSPN的超声特征进行分类,并进行单因素回归分析,总结恶性SSPN声像图特征。结果IOUS定位成功率为91.43%(32/35),高于VTE的48.57%(17/35),差异有统计学意义(χ2=15.310,P<0.001);IOUS定位时间(6.23±1.93)min,短于VTE的(9.98±1.56)min,差异有统计学意义(t=6.940,P<0.001)。IOUS定位的32例SSPN(17例恶性、15例良性)声像图均表现为低回声,单因素分析显示结节内回声不均匀(χ2=10.615,P=0.01)、边界不清(χ2=10.041,P<0.001)两种超声特征对判断良恶性有帮助。结论VATS中采用实时IOUS可对SSPN进行快速、准确定位和定性诊断,可节约手术时间,提高切除效率,对手术具有指导作用。Objective To investigate the diagnosis and treatment value of intraoperative ultrasound(IOUS)in video-assisted thoracic surgery(VATS)of small solitary pulmonary nodule(SSPN).Methods Of the 35 SSPN patients who received VATS in Tianjin Third Central Hospital from January 2016 to January 2020,the visual and touch examination(VTE)and IOUS method were used to locate pulmonary nodules during the operation.The differences between the two methods in the locating success rate and locating time were compared.The imaging findings of SSPN were classified and the sonographic characteristics of SSPN were summarized by univariate analysis.Results The success rate of IOUS locating was 91.43%(32/35),which was higher than that of VTE 48.57%(17/35),and the difference was statistically significant(χ2=15.310,P<0.001).The time of IOUS locating(6.23±1.93)min was shorter than that of VTE(9.98±1.56)min,and the difference was statistically significant(t=6.940,P<0.001).The sonograms of 32 SSPN(17 malignancy and 15 benign)patients were all hypoechoic,univariate analysis showed that heterogeneous echo(χ2=10.615,P=0.01)and unclear borderline(χ2=10.041,P<0.001)were helpful to judge the benign or malignant.Conclusions In video-assisted thoracic surgery,using IOUS could quickly and accurately locate and diagnose SSPN,which can shorten the operation time,improve the resection efficiency and guide the operation.

关 键 词：术中超声 孤立性肺小结节 电视胸腔镜手术 

分 类 号：R655.3[医药卫生—外科学] R445.1[医药卫生—临床医学]