胸腔镜术前低剂量CT引导下Hook-wire联合亚甲蓝定位肺局灶性磨玻璃样病变

Low-dose CT-guided Localization with a Hook-wire System Combined with Methylene Blue for Focal Ground-glass Opacity before Video-assisted Thoracoscopic Resection

目的探讨低剂量CT(low-dose CT,LDCT)引导下Hook-wire联合亚甲蓝定位在胸腔镜下肺局灶性磨玻璃样病变(focal ground-glass opacity,fGGO)切除术中的临床应用价值。方法 2010年11月～2012年4月对21例单侧fGGO(直径5～17 mm,平均11.5 mm,距壁层胸膜0～28 mm)行胸腔镜肺楔形切除术,术前皆行LDCT引导下Hook-wire定位,并辅以亚甲蓝染色。结果 LDCT引导下Hook-wire联合亚甲蓝定位成功率为100%,定位时间15～28 min,平均21 min。1例术中金属钩脱落,胸腔镜下观察肺组织表面血肿和亚甲蓝染色而成功手术切除;1例亚甲蓝染色失败,但Hook-wire锚定病灶亦成功手术切除。6例(28.6%)发生并发症,其中无症状气胸4例,无症状左上叶出血1例,无症状气胸和右下叶出血1例。VATS手术时间15～43 min,平均22 min;术中出血量23～38 ml,平均31 ml。术后住院5～12 d,平均7 d。fGGO术后病理:原位癌4例,微浸润腺癌3例,肺腺癌1例,不典型腺瘤样增生5例,错构瘤1例,间质性肺炎3例,肺内淋巴结增生2例,炎性肉芽肿2例。结论 LDCT引导下Hook-wire联合亚甲蓝定位fGGO的准确率高,并发症轻微。

Objective To evaluate low-dose CT （LDCT）-guided localization by using Hook-wire combined with methylene blue before video-assisted thoracoscopic surgery for pulmonary focal ground-glass opacity （fGGO）. Methods From November 2010 to April 2012, we performed video-assisted thoracoscopic wedge resection of the lung on 21 patients with unilateral fGGO （ the diameter of fGGO ranged from 5 to 17 mm with a mean of 11.5 mm, and the distance between the parietal pleura and the lesion was 0 to28 mm）. All the patients received LDCT-guided localization with Hook-wire and methylene blue. Results The success rate of LDCT- guided localization was 100%. The procedure was completed in a mean of 21 min （ranged from 15 to 28 min）. Intraoperative metal hook shedding occurred in one of the cases, but with video-assisted .thoracoscopy and staining with methylene blue to localize the lesion, the resection was completed successfully. In the other case, methylene blue staining failed, but the fGGO was removed by localizing the lesion with Hook-wlre. Six patients developed postoperative complications, including asymptomatic pneumothorax （4 cases） , asymptomatic bleeding in the left upper lobe （ 1 case）, and asymptomatic pneumothorax complicated with right lower lobe hemorrhage （ 1 case）. The mean operation time for video-assisted thoracoscopic surgery was 22 min （ 15 - 43 min） , and the mean intraoperative blood loss was 31 ml （23 -38 ml）. The patients were discharged from hospital in a mean of 7 days after the procedure （5 - 12 days）. Postoperative pathological examination showed carcinoma in situ in 4 cases, microinvasive adenocarcinoma in 3 cases, pulmonary adenocarcinoma in 1, atypical adenomatous hyperplasia in 5, hamartoma in 1, interstitial pneumonia in 3, intrapulmonary lymph node hyperplasia in 2, and inflammatory granuloma in 2. Conclusion LDCT-guided localization by using Hook-wire combined with methylene blue is accurate for fGGO with mile complications.