CT引导下一次性肺结节定位针在单操作孔电视胸腔镜肺结节手术前肺结节定位中的应用  

Application of CT-guided disposable pulmonary nodule positioning needle in preoperative pulmonary nodule localization in single-operation-hole video-assisted thoracoscopic surgery for pulmonary nodule

作　　者：张宇[1] 郭彦璞 王辉 寇海涛[1] 于海明[1] 朱勇[1] 王相臣[1] ZHANG Yu;GUO Yanpu;WANG Hui;KOU Haitao;YU Haiming;ZHU Yong;WANG Xiangchen(Department of Thoracic and Cardiovascular Surgery,Puyang People's Hospital,Puyang 457000,Henan Province,China;Department of Imaging,Puyang People's Hospital,Puyang 457000,Henan Province,China)

机构地区：[1]濮阳市人民医院心胸外科,河南濮阳457000 [2]濮阳市人民医院影像科,河南濮阳457000

出　　处：《新乡医学院学报》2022年第7期648-652,共5页Journal of Xinxiang Medical University

摘　　要：目的评估CT引导下一次性肺结节定位针用于单操作孔电视胸腔镜肺结节手术前肺结节定位的安全性与有效性。方法选择2019年11月至2021年12月于濮阳市人民医院行单操作孔电视胸腔镜肺结节手术治疗的57例患者为研究对象。患者均行CT引导下一次性肺结节定位针经皮穿刺肺结节定位,于定位当天行单操作孔电视胸腔镜手术切除结节。观察患者穿刺定位操作时间、定位成功率、定位针进入肺深度、手术切除率和并发症发生情况。结果对57例患者共定位肺结节60枚,其中1例同期定位2枚结节,1例同期定位3枚结节。穿刺定位操作时间为(19.2±9.9)min;定位失败1例,定位成功56例,定位成功率为98.3%(56/57);定位针进入肺深度(25.8±9.9)mm;结节距胸膜的距离为(14.0±9.7)mm。所有结节均在单操作孔胸腔镜下切除,手术切除率为100.0%,其中肺叶切除22枚(36.7%),肺段切除16枚(26.6%),楔形切除22枚(36.7%)。穿刺定位术后发生少量气胸14例,肺内出血2例,患者均无症状,均无需放置胸管或急诊手术处理;无胸腔积血和咯血患者。多因素logistic回归分析显示,穿刺定位操作时间和结节距胸膜的距离是CT引导下一次性肺结节定位针穿刺定位患者气胸发生的危险因素(比值比=5.934、1.137,P<0.05);吸烟、结节位置、定位针进入肺深度与CT引导下一次性肺结节定位针穿刺定位患者术后气胸的发生无关(P>0.05)。术后病理诊断为恶性及癌前病变51枚(85.0%),其中浸润性腺癌38枚(63.3%),微浸润性腺癌2枚(3.3%),原位腺癌5枚(8.3%),鳞状细胞癌2枚(3.3%),不典型腺瘤样增生3枚(5.0%);良性病变9枚(15.0%),其中错构瘤3枚(5.0%),结核1枚(1.7%),纤维化结节4枚(6.7%),淋巴结反应性增生1枚(1.7%)。结论采用CT引导下一次性肺结节定位针用于术前肺结节定位成功率高、并发症少,能够有效提高肺结节手术切除率。Objective To evaluate the safety and effectiveness of CT-guided disposable pulmonary nodule positioning needle for preoperative pulmonary nodule localization in single-operation-hole video-assisted thoracoscopic surgery for pulmonary nodule.Methods A total of 57 patients with pulmonary nodules who underwent single-operation-hole thoracoscopic surgery in Puyang People's Hospital from November 2019 to December 2021 were selected as research subjects.All patients underwent CT-guided disposable pulmonary nodule positioning needle throug percutaneous puncture to locate the pulmonary nodule.On the day of localization,the nodules were removed by single-operation-hole video-assisted thoracoscopic surgery.The operation time of puncture localization,success rate of localization,depth of positioning needle into the lung,distance from tubercle to pleura,resection rate and complications were observed.Results A total of 60 pulmonary nodules were located in 57 patients,including 2 nodules in 1 case and 3 nodules in 1 case.The operation time of puncture localization was(19.2±9.9)min;1 case failed to locate,the localization was successful in 56 cases,and the success rate of localization was 98.3%(56/57).The depth of positioning needle into the lung was(25.8±9.9)mm,the distance from tubercle to pleura was(14.0±9.7)mm.All nodules were resected under single-operation-hole video-assisted thoracoscopic surgery,and the resection rate was 100.0%,including lobectomy for 22 nodules(36.7%),segmental lobectomy for 16 nodules(26.6%),wedge resection for 22 nodules(36.7%).After nodule location,there were 14 cases of pneumothorax and 2 cases of pulmonary hemorrhage,all the patients were asymptomatic and did not need to place chest tube or emergency operation;there were no patients with hemopleural effusion and hemoptysis.Multivariate logistic regression analysis showed that the operation time of puncture localization and the distance from tubercle to pleura were the risk factors of pneumothorax in patients with CT-guided puncture and localiz

关 键 词：肺结节定位针 肺结节 术前定位 胸腔镜 

分 类 号：R734.2[医药卫生—肿瘤]