CT引导单双钩Hook-wire定位在胸腔镜手术中的应用研究  

Application of preoperative CT guided hook wire localization in thoracoscopic surgery of pulmonary nodules

作　　者：李斌 黎良山 高益萍 王省白[1] 张晓华 LI Bin;LI Liangshan;GAO Yiping(Department of Radiology,Jiaxing Traditional Chinese Medicine Hospital,Jiaxing 314001,China)

机构地区：[1]嘉兴市中医医院放射科,浙江嘉兴314001

出　　处：《全科医学临床与教育》2021年第1期30-32,36,共4页Clinical Education of General Practice

基　　金：浙江省医药卫生科技计划面上项目(2019KY703);嘉兴市科技计划项目(2017AY33057)。

摘　　要：目的探讨术前CT引导下单钩与双钩Hook-wire定位技术在肺小结节胸腔镜切除术中的应用价值。方法选取拟行胸腔镜肺楔形切除术的98例125处肺小结节患者。采用随机数字表法将其分为单钩组与双钩组,单钩组49例患者64处病灶接受术前CT引导下单钩Hook-wire定位,双钩组49例患者61处病灶则接受双钩Hook-wire定位,比较两组定位效果及患者预后情况。结果两组患者的定位操作时间、肺小结节平均直径以及结节至壁层胸膜平均距离比较,差异均无统计学意义(t分别=0.11、0.24、0.12,P均>0.05);两组均未发生血胸、空气栓塞等严重并发症。双钩组患者出血发生率、术中脱钩率明显低于单钩组(χ^2=5.04、8.09,P均<0.05),两组气胸发生率比较,差异无统计学意义(χ^2=0.44,P>0.05)。双钩组中结节位置至壁层胸膜距离>20 mm的患者气胸发生率与距离≤20 mm患者比较无显著差异(χ^2=0.01,P>0.05),但距离>20 mm患者出血率及脱钩率高于距离≤20 mm患者,差异有统计学意义(χ^2分别=3.87、3.87,P均<0.05)。结论肺小结节胸腔镜切除术前采用CT引导双钩Hook-wire定位技术能够有效降低钩丝定位脱钩风险,尤其对位置相对表浅的结节病灶定位效果更为理想,对肺小结节胸腔镜术前定位具有重要的指导意义与临床价值。Objective To explore the application value of single-hook and double-hook hook-wire localization techniques under CT guidance in small tuberculous thoracoscopy.Methods Totally 98 patients with 125 pulmonary nodules who underwent thoracoscopy pulmonary wedge resection were selected as the research subjects and divided into singlehook group and double-hook group by random number table method.Totally 49 patients with 64 lesions received singlehook hook-wire positioning under preoperative CT guidance,49 patients with 61 lesions received double hook hook-wire positioning.The positioning effect and prognosis between two groups were compared.Results There was no significant difference in the time of localization operation,the average diameter of pulmonary nodules,and the average distance from nodule to pariet al pleura(t=0.11,0.24,0.12,P>0.05).There was no serious complications occurred in both groups,such as hemothoraxand air embolism.The incidence of bleeding and intraoperative decoupling rate in double-hook group were significantly lower than those in the single-hook group(χ^2=5.04,8.09,P<0.05).However,there was no significant difference in the incidence of pneumothorax(χ^2=0.44,P>0.05).In the double hook group,there was no significant difference in the incidence of pneumothorax between the patients whose distance from nodule to parietal pleura longer than 20mm and shorter than 20mm(χ^2=0.01,P>0.05).While the incidence of bleeding and intraoperative decoupling rate of the patients whose distance from nodule to parietal pleura longer than 20 mm were higher than those of patients whose distance from nodule to parietal pleura shorter than 20mm(χ^2=3.87,3.87,P<0.05).Conclusion Before thoracoscopic resection of pulmonary nodules,CT-guided double-hook hook-wire positioning technology can effectively reduce the risk of hook wire positioning decoupling.Particularly,it is more ideal for positioning the superficial nodular lesions.It has important guiding significance and clinical value for the thoracoscope positioning of

关 键 词：CT术前引导 单/双钩Hook-wire定位技术 肺小结节 胸腔镜下肺楔形切除术 临床疗效 

分 类 号：R655.3[医药卫生—外科学]