胸腔镜术前CT导引下不同路径钩丝定位≤10 mm肺磨玻璃结节比较研究  

CT-guided hook-wire localization of<10 mm pulmonary ground-glass nodules via different path ways before video-assisted thoracoscopic surgery:a comparative study

作　　者：邹兴雄 夏俊杰[2] 李宏伟 杨俊强 邱宇[2] 杨明[2] 李文军[2] 谢文英 薛会红 游婧秀 嘎米 王娟[2] ZOU Xingriong;XIA Junjie;LI Hongwei;YANG Junqiang;QIU Yu;YANG Ming;LI Wenjun;XIE Wenying;XUE Huihong;YOU Jingriu;GA Mi;WANG Juan(Department of Radiology,The Third Hospital of Mianyang(Sichuan Provincial Mental Health Center),Mianyang,Sichuan Province 621000,China)

机构地区：[1]绵阳市第三人民医院(四川省精神卫生中心)放射科,四川绵阳621000 [2]绵阳市第三人民医院(四川省精神卫生中心)呼吸与危重症医学科,四川绵阳621000

出　　处：《介入放射学杂志》2024年第8期884-890,共7页Journal of Interventional Radiology

基　　金：四川省绵阳市第三人民医院科研项目(202009)。

摘　　要：目的比较电视辅助胸腔镜手术(VATS)前CT导引下不同路径钩丝定位≤10 mm肺磨玻璃结节的安全性和有效性。方法回顾性分析2018年7月至2023年3月在绵阳市第三人民医院接受VATS前CT导引下钩丝定位的128例≤10 mm肺磨玻璃结节患者临床资料。根据定位路径将患者分为垂直组(88例)和非垂直组(40例)。记录两组穿刺针数、定位手术持续时间、穿刺成功率、VAST手术时间、穿刺相关并发症等。结果两组患者性别、年龄、吸烟史、结节部位、穿刺体位、结节大小、结节密度特征、肺气肿情况、胸膜至病灶深度比较差异无统计学意义(均P>0.05)。垂直组与非垂直组相比,穿刺针数较少、定位手术持续时间较短、气胸发生率较低、VATS手术时间较短,差异有统计学意义(均P<0.05)。被肋骨遮挡肺结节亚组分析也得出同样结果。二元logistic回归分析显示,非垂直穿刺、穿刺针数是气胸发生的独立危险因素。结论VAST术前CT导引下钩丝定位法定位≤10 mm肺磨玻璃结节安全有效。在确保病灶定位于2.0 cm范围内并有效避开肋骨、血管等遮挡情况下,优先选择垂直于胸膜进针可有效降低气胸发生率、缩短VAST手术时间。Objective To compare the clinical safety and efficacy of CT-guided hook-wire localization of≤10mm pulmonary ground-glass nodule(GGN)via different path ways before videoassisted thoracoscopic surgery(VATS).Methods The clinical data of a total of 128 patients with≤10 mm pulmonary GGN,who received CT-guided hook wire localization before VATS at The Third Hospital of Mianyang of China between July 2018 and March 2023,were retrospectively analyzed.According to the puncturing localization path way mode,the patients were divided into vertical puncturing group(n=88)and non-vertical puncturing group(n=40).The number of puncturing times,the time spent for puncturing localization,the success rate of puncture,the operation time of VATS,and puncture-related complications of the two groups were recorded.Results No statistically significant differences in the gender,age,smoking history,GGN location,puncture position,nodule size,density characteristics of GGN,emphysema,and nodules-pleura distance existed between the two groups(all P>0.05).Compared with non-vertical puncturing group,in vertical puncturing group the number of puncturing times was smaller,the time spent for localization was shorter,the incidence of pneumothorax was lower,and the operation time of VATS was shorter,the differences in all the above indexes between the two groups were statistically significant(all P<0.05);and the subgroup analysis of patients whose GGN was overlapped with rib shadow obtained the same results.Binary logistic regression analysis revealed that non-vertical puncturing and the number of puncturing times were the independent risk factors for the occurrence of pneumothorax.Conclusion CT-guided hook-wire localization of≤10mm pulmonary GGN before VATS is clinically safe and effective.Under the condition when the lesion can be localized within the range of 2.Ocm and the shadow overlapping of GGN with the rib and blood vessel can be effectively avoided,vertical puncturing path way mode should be preferred,which can effectively reduce the in

关 键 词：CT定位 钩丝定位 肺结节 胸腔镜 

分 类 号：R734.2[医药卫生—肿瘤]