横截面CT指导术中直视下定位肺微小结节:斜裂线-表盘定位法

Cross-sectional CT guidance for positioning small pulmonary nodules under direct vision:oblique line-dial positioning

目的指导并提高肺部微小结节胸腔镜手术切除的精准性。方法前瞻性分析2017年8月至2019年8月南京医科大学附属南京医院心胸外科的100例肺结节的临床资料,所有患者均在术中直视下应用横截面CT斜裂线-表盘定位法定位,以CT引导下Hook-Wire定位针或带尾丝弹簧圈的定位点作为标准定位点来评估该定位方法的符合率。评判标准:肺半萎陷状态,采用斜裂线-表盘定位法的定位点处于标准定位点周边直径5mm范围内为精准,6mm^10mm范围内为亚精准,大于10mm为偏差。精准和亚精准认为符合。结果横截面CT斜裂线-表盘定位法的定位点和标准定位点的总体符合率的点估计为95%,95%可信区间为(90.7%,99.3%),两者距离的总体均数点估计为5.43mm,标准差为2.91mm,95%可信区间为(4.86mm,6.01mm)。结论运用横截面CT斜裂线-表盘定位法定位和CT引导下Hook-Wire定位针或带尾丝弹簧圈定位两者的符合率高,距离误差小,且无创、简便、快捷,作为一种辅助方法值得临床推广应用。

Objective To guide and improve the accuracy of thoracoscopic resection of small nodules in lung.Methods The clinical data of 100 pulmonary nodules in the Department of Cardiothoracic Surgery,Nanjing Hospital Affiliated to Nanjing Medical University from August 2017 to August 2019,were prospectively analyzed.All patients underwent cross-sectional CT oblique line-dial positioning method under direct vision.The CT-guided HookWire locating needle or the positioning point of the tail wire spring coil was used as the standard positioning point to evaluate the coincidence rate of the positioning method.Judging criteria was:while the lungs were semi-collapse state,the positioning point using the oblique splitting-dial positioning method was accurate within the range of 5 mm around the standard positioning point,sub-precision within the range of 6 mm^10 mm,and deviation of more than 10 mm.Accuracy and sub-precision were considered to be consistent.Results The point of cross-section CT oblique line-dial positioning method and the standard alignment point of the standard positioning point was estimated to be 95%,and the 95%confidence interval was(90.7%,99.3%).The number was estimated to be 5.43 mm,the standard deviation was 2.91 mm,and the 95%confidence interval was(4.86 mm,6.01 mm).Conclusion The cross-section CT oblique line-dial positioning method and CT-guided HookWire locating needle or the tail wire spring ring positioning have high coincidence rate,small distance error,and non-invasive,simple and fast as an auxiliary method,which is worthy of widely clinical application.