三维导航免穿刺和穿刺定位行解剖性肺段切除术治疗肺结节的回顾性队列研究  

Puncture positioning versus free-of-puncture positioning under three-dimensional navigation in the anatomical segmentectomy for pulmonary nodules:A retrospective cohort study

作　　者：胡硕 王琦[1] 魏海星 潘相龙 何志成[1] 许晶[1] 朱燚宁 吴卫兵[1] 陈亮[1] HU Shuo;WANG Qi;WEI Haixing;PAN Xianglong;HE Zhicheng;XU Jing;ZHU Yining;WU Weibing;CHEN Liang(Department of Thoracic Surgery,The First Affiliated Hospital with Nanjing Medical University,Nanjing,210029,P.R.China)

机构地区：[1]南京医科大学第一附属医院胸外科,南京210029

出　　处：《中国胸心血管外科临床杂志》2021年第10期1202-1206,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：江苏省“六大人才高峰”(WSW-028);吴阶平医学基金会临床科研专项(320.2730.1868);江苏省人民医院“511腾飞工程”基金(JSPH-511B-2018-6)。

摘　　要：目的探讨在三维导航下免穿刺定位行解剖性肺段切除术治疗肺磨玻璃结节(ground-glass nodule,GGN)的可行性及临床价值。方法回顾性分析2018年10月至2019年6月268例行解剖性肺段切除术患者的临床资料,其中男75例、女193例,平均年龄(56.55±12.10)岁。穿刺定位组89例,免穿刺定位组179例。分析并比较两组患者的围术期资料。结果穿刺定位组平均靶区CT扫描次数(3.01±0.98)次,穿刺数字疼痛评分(3.98±1.61)分,穿刺后肺压缩30%以上气胸7例(7.87%),肋间血管损伤出血8例(8.99%)。穿刺定位组与免穿刺定位组均顺利发现和切除结节。两组结节位置(P=0.466)、手术时间[(151.83±39.23)min vs.(154.35±33.19)min,P=0.585]、病灶切缘宽度[(2.07±0.35)cm vs.(1.98±0.28)cm,P=0.750]、切除亚段数(2.83±1.13 vs. 2.73±1.16,P=0.530)差异均无统计学意义。结论三维导航免穿刺定位解剖性肺段切除技术避免了穿刺不利因素,可替代穿刺定位技术应用位于肺段或亚段中央区域,或邻近段间静脉的肺GGN。Objective To explore the feasibility and clinical value of free-of-puncture positioning in threedimension-guided anatomical segmentectomy for ground-glass nodule(GGN) compared with percutaneous positioning.Methods Clinical data of 268 enrolled patients undergoing anatomical pulmonary segmentectomy from October 2018 to June 2019 were retrospectively collected, including 75 males and 193 females with an average age of 56.55±12.10 years. The patients were divided into two groups, including a percutaneous positioning group(n=89) and a free-of-puncture positioning group(n=179). Perioperative data of the two groups were compared. Results The average CT scan times of the percutaneous positioning group was 3.01±0.98 times, and the numerical rating scale(NRS) score of puncture pain was3.98±1.61 points. Pulmonary compression pneumothorax(≥30%) occurred in 7(7.87%) patients and intercostal vascular hemorrhage occurred in 8(8.99%) patients after puncture. Lung nodules were successfully found and removed in both groups. There was no statistically significant difference between the two groups in the location of nodules(P=0.466),operation time(151.83±39.23 min vs. 154.35±33.19 min, P=0.585), margin width(2.07±0.35 cm vs. 1.98±0.28 cm,P=0.750), or the number of excised subsegments(2.83±1.13 vs. 2.73±1.16, P=0.530). Conclusion Anatomical segmentectomy with three-dimensional navigation avoids the adverse consequences of puncture, which has the same clinical efficacy and meets the requirements of oncology compared with percutaneous positioning. The free-of-puncture positioning method can be used for GGN located in the central region of pulmonary segment/subsegment or adjacent to intersegment veins instead of percutaneous positioning.

关 键 词：磨玻璃结节 三维重建 术前定位 肺段切除术 

分 类 号：R734.2[医药卫生—肿瘤]