CT引导Hookwire定位下电视胸腔镜手术对孤立性肺小结节的诊疗价值

The diagnosis value of CT guidance Hookwire positioning thoracoscopic surgery for solitary pulmonary nodule

背景与目的:临床检查发现,孤立性肺小结节(solitary pulmonary nodule,SPN)包含了相当一部分的早期肺癌。本研究探讨CT引导Hookwire定位下胸腔镜手术对于SPN的诊疗价值。方法:从2011年7月至2013年6月,复旦大学附属肿瘤医院胸外科收治的SPN患者310例,CT引导下留置Hookwire定位针,行胸腔镜(video assisted thoracic surgery,VATS)肺楔形切除,根据术中冰冻病理结果决定进一步治疗方式。统计定位准确率、并发症发生率、VATS肺楔形切除手术成功率、中转开胸率以及SPN病理分型等。结果:Hookwire定位成功率为100%,咯血2例需要处理,术中Hookwire脱落12例(3.87%),VATS肺楔形切除手术成功率为99.0%,中转开胸3例。SPN术后组织学病理结果:原发性肺癌237例,良性病变73例。结论:采用CT引导Hookwire定位下VATS手术的方法治疗微小SPN,诊断准确率高、疗效可靠,并发症少,具有很好的临床推广价值。

Background and purpose： Lung cancer is currently the greatest threat to human life and health of the malignant tumor, clinical examination revealed a solitary pulmonary nodules （SPN）, including a significant portion of early stage lung cancer. The research aimed to discuss the diagnosis value of CT guidance Hookwire positioning thoracoscopic surgery for solitary pulmonary nodule. Methods： From Jul. 2011 to Jun. 2013, 310 SPN patients in the Department of Thoracic Surgery of Fudan University Shanghai Cancer Center were collected. Hookwire positioning pins were retained guided by CT scan into the patients＇ body. Video assisted thoracic surgery （VATS） pulmonary wedge resection was adopted. According to the result of intraoperative frozen pathology, further treatment method was decided. Positioning accuracy, complications, VATS lung wedge resection surgery successful rate, transfer rate in the chest and SPN pathological classification and other indicators were calculated with statistical methods. Results： Hookwire positioning successful rate was 100%, meanwhile, 2 patients with hemoptysis received symptomatic treatment.Intraoperative Hookwire fell off in 12 patients （3.87%）, VATS wedge resection surgery successful rate was 99%, transit thoracotomy was carried out in 3 patients. SPN postoperative histological pathology results： 237 cases with primary lung cancer, 73 cases with benign lesions. Conclusion： The method of CT guided Hookwire thoracoscopic surgery after positioning in treatment of SPN has higher diagnostic accuracy rate, reliable curative effect, fewer complications and great value in clinical promotion.