CT引导下新型定位器拖尾法定位肺内小结节的应用  

A preliminary study to evaluate the efficacy and safety of CT-guided localization of pulmonary nodules with soft wire hook-wire by trailing technique

作　　者：李凤卫[1] 辛兴[1] 陈应泰[1] 边建伟[1] 王彦杰 姜瑞恒 杨顺武 吴迅[1] 刘思杰[1] Li Fengwei;Xin Xing;Chen Yingtai;Bian Jianwei;Wang Yanjie;Jiang Ruiheng;Yang Shunwu;Wu Xun;Liu Sijie(Department of Thoracic Surgery,Beijing Aerospace General Hospital,Beijing 100076,China)

机构地区：[1]北京航天总医院胸外科,北京100076

出　　处：《中国医师进修杂志》2023年第5期406-410,共5页Chinese Journal of Postgraduates of Medicine

基　　金：首都临床诊疗技术研究及转化应用(Z201100005520071);首都临床特色应用研究(Z181100001718055);2020年北京航天总医院创新基金(2020-601)。

摘　　要：目的探讨拖尾法一次性肺结节定位针用于肺内小结节术前定位的安全性、有效性。方法回顾性分析北京航天总医院2020年11月至2022年3月185例肺内小结节患者(211枚结节)的临床资料。患者于术前采用新型定位器拖尾法定位肺内小结节,然后进行胸腔镜下手术(VATS)。统计分析定位操作相关数据、成功率、并发症、病理结果等。结果定位成功率97.63%(206/211),VATS切除成功率99.53%(210/211),CT定位时间(7.19±2.62)min,切除病灶所需时间平均为27 min(10~126 min)。术中发现金属抓钩脱位回缩至胸膜腔2例,通过肺表面穿刺点,成功定位肺内结节并予以切除;发现金属钩位于叶间裂3例,通过金属钩位置并适当扩大切除范围成功切除肺内结节。49例患者定位后发生微量气胸,但无需闭式引流处理;12例患者出现肺内血肿;15例患者出现胸痛,予以镇痛治疗。结论采用拖尾法一次性肺结节定位针用于肺内小结节术前定位更简便、安全、有效,值得推广。Objective The purpose of this study was to investigate the clinical value of CT-guided localization of pulmonary nodules with soft wire hook-wire by trailing technique.Methods The clinical data of 211 pulmonary nodules of 185 patients from November 2020 to March 2022 in Beijing Aerospace General Hospital were retrospectively analyzed.The pulmonary nodules were localized with soft wire hook-wire by trailing technique before video-assisted thoracic surgery(VATS).The success rate,complications,pathological results and localization operations related data were statistically analyzed.Results The success rate of localization was 97.63%(206/211),and the success rate of VATS removal was 99.53%(210/211).The average operation time was(7.19±2.62)min,and the average time required for resection of lesions was 27 min(10 to 126 min).During the surgery,the soft wire hook-wire of two patient was found to be dislocated and retracted into the chest wall.The pulmonary nodules were successfully located and removed according traces left by puncture points on the lung surface.It was found that the hook-wire was located in the interlobar fissure in 3 patients.The pulmonary nodules were successfully removed by the hook-wire position and appropriately expanding the resection range.A minor pneumothorax occurred in 49 patients,but no closed drainage was needed;12 patients developed intrapulmonary hematoma;15 patients with chest pain were treated with analgesia.Conclusions For small pulmonary nodules requiring thoracoscopic surgery,the computed tomography-guided pulmonary nodule localization with soft wire hook-wire by trailing technique is more convenient,safe and effective,and is worthy of promotion to use.

关 键 词：肺肿瘤 全肺切除术 断层扫描 定位 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]