术前CT引导下亚甲蓝与Hookwire联合定位肺小结节临床应用价值

CT-guided localization with combination of methylene blue and a Hookwire system for small pulmonary nodules before video-assisted thoracoscopic resection： the clinic application

目的探讨cT引导下亚甲蓝与Hookwire联合定位在胸腔镜下孤立性肺小结节（SPN）切除术中的临床应用价值。方法对56例患者的60枚SPN术前行CT引导下亚甲蓝与Hookwire联合定位后行胸腔镜（VATS）肺楔形切除术。全组患者男19例，女37例；年龄35—81岁，平均（61．1±8．9）岁。结果56例60枚SPN直径为（6．80±4．12）mm，距壁层胸膜（15．38±4．63）mm。CT引导下定位成功率100％，定位时间（10．76±8．17）min。定位后5例（8．9％）发生局部少量气胸，4例（7．1％）发生肺出血，均无需治疗。60枚肺小结节病灶均准确定位，VATS楔形切除术成功率100％。术后病理显示，肺泡细胞癌（BAC）33枚（55．0％），肺泡细胞癌伴腺癌（BAC＋AC）11枚（18．3％），肺泡细胞不典型增生（AAH）7枚（11．8％），炎性肉芽肿4枚（6．7％），错构瘤3枚（5．0％），结核性肉芽肿2枚（3．3％）。结论胸腔镜术前CT引导下亚甲蓝与Hookwire联合定位准确率高，对胸腔镜手术（VATS）楔形切除病灶有极大的帮助作用，具有良好的临床应用价值。

Objective To evaluate the clinical application of CT-guided localization with combination of methylene blue and a Hookwire system for small pulmonary nodules （SPNs） before video-assisted thoraeoseopic resection. Methods CT- guided localization the SPNs before resection in 56 patients and 60 nodules, then underwent video-assisted thoracic surgery （VATS） resection. Among 56 patients, 19 males and 37 females, aged from 35 to 81 years, mean age was （61.1 ± 8.9） years. Results SPNs diameter （6. 80± 4. 12 ）mm , distance from the parietal pleura （ 15.38 ± 4. 63 ） mm . CT-guided localization success rate was 100% , positioning time （ 10. 76 ± 8.17 ） rain, 8.9% （5/56） had micro pneumothorax after positioning, 7. 1% （4/56）occurrence of needle tract bleeding, no conservative treatment. VATS resection rate was 100%. The pathology of 60 lesions were shown ： Bronchiolo-alveolar carcinoma（ BAC ） were 33 lesions （ 55.0% ） , BAC and adenocarcinoma were 11 lesions （ 18.3 % ）, Atypiealadenomatous hyperplasia （ AAH ） were 7 lesions （ 11.8 % ） , Inflammation were 4 lesions （6.7 % ） , Harmatoma were 3 lesions （5.0%） , Tuberculoses were 2 lesions （3.3 % ）. Conclusion CT-guided localization with combination of methylene blue and a Hookwire system before video-assisted thoracoscopic resection is a promising technique for small solitary pulmonary nodules. It could play an important role in accurate localization of small pulmonary nodules, and it is a safe technique with clinical application.