CT引导下hook-wire定位在肺小结节胸腔镜切除术中的应用价值

The value of CT-guided hook-wire localization of small pulmonary nodules in video-assisted thoracoscopic surgery

目的探讨CT引导下hook-wire定位在肺小结节(SPN)电视辅助胸腔镜手术(VATS)中的应用价值。方法回顾性分析本院2013年1—6月170例患者191个SPN于VATS术前行CT引导下hook-wire定位技术,并统计该技术的成功率、定位时间、并发症、VATS转开胸手术率、住院时间及所需费用、SPN平均大小及其距脏层胸膜距离、病理学检查等。结果 CT引导下hook-wire定位成功率为100%,平均定位时间为(11±4)min;平均VATS楔形切除术时间和肺叶切除时间分别为(16±2)min和(95±30)min;患者术后平均住院时间为(5.77±2.1)d,平均治疗费用为(44 469.02±12 916.63)元;定位后无症状气胸发生率为10.0%,无症状出血发生率为35.9%,无症状气胸合并出血发生率为5.9%,7例(4.1%)患者由VATS转开胸手术,2例(1.2%)发生脱落;SPN平均大小为(13.5±6.4)mm,距脏层胸膜平均距离为(11.1±9.7)mm;恶性SPN占75.9%;磨玻璃密度影(GGO)的恶性率比实性结节大。结论 CT引导下hook-wire术前定位降低了开胸手术比率和并发症发生率,减少了住院时间,减轻了患者治疗经济负担,对不典型SPN具有巨大的诊断和治疗价值。

Objective To investigate the clinical application value of computed tomography(CT)-guided hook-wire localization of small pulmonary nodules(SPNs) in video-assisted thoracoscopic surgery(VATS). Methods From January to June 2013, a total of 170 patients with 191 SPNs who had undergone CT-guided hook-wire localizatin before VATS were studied retrospectively. The localization achievement ratio, mean time of surgery, complication rate, conversion thoracotomy rate, mean hospital stay and expense, average size of SPNs, distance between SPNs and visceral pleura and pathology were assessed. Results Preoperative CT-guided hook-wire localization was performed in all patients. The mean time of localization, wedge resection and lobe resection was(11±4) min,(16±2) min and(95±30) min respectively. The mean hospital stay was(5.77±2.1) days and the average expense was(44 469.02±12 916.63) yuan RMB. Postoperative complications after localization occurred in 90 patients(52.9%), 17 with asymptomatic pneumothorax, 61 with asymptomatic hemorrhage, 10 with simultaneous pneumothorax and hemorrhage and 2 with intraoperative dislodgement. Conversion thoracotomy was required in 7 with patients(4.1%).The average size of SPNs was(13.5±6.4) mm, and the average distance between SPNs and visceral pleura was(11.1±9.7) mm. Histological assessment revealed that the malignant SPNs accounted for 75.9% and the fact that ground-glass opacities(GGOs) were much more probably malignant than solid nodules was confirmed. Conclusion Conclusion Preoperative CT-guided hook-wire localization of SPNs in VATS can decrease the complication rate, conversion thoracotomy rate and hospital stay, and relieve the financial burden in the patients, with great clinical value of diagnosis and treatment of SPNs.