金属介导的两种肺结节定位方法在胸腔镜精准肺切除手术中的应用  

Application of two metal-mediated pulmonary nodule localization methods in thoracoscopic precise pneumonectomy

作　　者：张灵敏 曾莉 朱龙飞 王如文 蒋彬 ZHANG Lingmin;ZENG Li;ZHU Longfei;WANG Ruwen;JIANG Bin(Department of Thoracic Surgery,Army Characteristic Medical Center,Chongqing 400042,China)

机构地区：[1]陆军特色医学中心胸外科,重庆400042

出　　处：《重庆医学》2023年第11期1651-1654,1658,共5页Chongqing medicine

基　　金：重庆市科卫联合医学科研项目(2020FYYX061)。

摘　　要：目的探讨金属介导的两种肺结节定位方法在胸腔镜肺切除手术中的临床应用价值。方法回顾性分析该院自2017年1月1日至2021年6月1日共194例肺磨玻璃结节手术患者的临床资料,术前均行计算机断层扫描(CT)引导下穿刺定位,其中应用带钩金属丝定位法(Hook-wire)定位为A组(n=66),应用四爪锚定针定位为B组(n=128);两组患者均行胸腔镜下肺切除手术。收集并比较两组患者围术期临床资料。结果两组患者均顺利完成手术,均无中转开胸;A组66例患者切除总结节数为81个,B组128例患者切除总结节数180个。两组患者在一般资料和围术期相关数据方面比较,差异无统计学意义(P>0.05)。两组患者的穿刺并发症在气胸、血胸、肺内血肿及总体并发症方面比较,差异无统计学意义(P>0.05),但A组患者的脱钩率高于B组,差异有统计学意义(P=0.042)。结论Hook-wire和四爪锚定针均有助于肺磨玻璃结节的精准定位和切除,四爪锚定针的脱钩率低于Hook-wire针,定位更可靠。Objective To explore the clinical application value of two metal-mediated pulmonary nodule localization methods in thoracoscopic lung resection.Methods The clinical data from 194 consecutive patients with pulmonary ground-glass nodules in this hospital from January 2017 to June 2021 were retrospectively collected.All the patients underwent computed tomography(CT)-guided puncture before operation,in which Hook-wire needle was used as group A(n=66)and four-claw anchor needle was used as group B(n=128).Thoracoscopic pneumonectomy was performed in both groups.The perioperative clinical data of the two groups were collected and compared.Results All operations were successfully completed in both groups without conversion to thoracotomy.A total of 81 nodules were localized and removed in group A,and 180 nodules in group B.There was no significant difference in general data and perioperative data between the two groups(P>0.05).There was no significant difference between the two groups in the complications of puncture,such as pneumothorax,hemothorax and intrapulmonary hematoma and overall complications(P>0.05),but the decoupling rate of patients in group A was higher than that in group B,with statistical difference(P=0.042).Conclusion Preoperative localization of ground-glass nodules with both Hook-wire and four-claw anchor needle proved to be useful and effective.However,anchor with scaled suture is more reliable way of localization due to the significantly lower decoupling rates.

关 键 词：胸腔镜手术 肺结节 HOOK-WIRE 四爪锚定针 术前定位 

分 类 号：R734.2[医药卫生—肿瘤]