孤立性肺结节术前MSCT图像后处理并钩丝定位

Post-processing in MSCT-guided localization with a Hook-wire system for nodular pulmonary lesions before video-assisted thoracoscopic resection

目的:评价MSCT图像后处理并钩丝定位技术对孤立性肺结节胸腔镜术前的临床应用价值。方法:55例肺结节患者,经MSCT图像后处理后植入Hook-wire定位钩丝,明确钩丝、肺结节、邻近血管、支气管、胸膜的关系;胸外科医师在胸腔镜术中先评估能否仅通过触摸法定位病灶;不能肯定者采用钩丝定位,最后经手术验证其准确性。2种定位方法的差异进行统计学分析。结果:MSCT图像后处理技术引导下穿刺定位全部成功(100%),平均操作时间(13.5±7.8)min。胸腔镜术中通过触摸法定位结节,符合率为78.2%(43/55);采用钩丝准确定位结节55例,符合率为100%(55/55);两者间差异具有统计学意义(χ2=13.47,P<0.01)。术后病理学检查均获得明确诊断。结论:胸腔镜切除肺结节术前行MSCT图像后处理并钩丝定位技术,操作安全,定位准确有效,能缩短胸腔镜手术时间,降低转为开胸手术的概率,具有较好的临床应用价值。

[Abstract] Objective：To evaluate the feasibility of post-processing in MSCT-guided localization with hook-wire for solitary pulmonary nodule （SPN） before video-assisted thoracoscopic surgery （VATS）. Methods：55 cases of solitary pulmonary nodules, whose images were MSCT post-processed, were localized by hook-wire. The images showed the exact relationship between hook-wire, pulmonary nodules, blood vessels, bronchi and pleura. Thoracic surgery doctors in thoracoscopic procedures first evaluated whether lesions could be positioned only through the finger palpation;if not,they were localized by hook-wire. The surgery verified its accuracy finally. The differences bitween these two kinds of positioning method were statistically inspected. Results;Preoperative MSCT-guided hook-wire localization after MSCT post-processing was successful in all patients （100%）. The average localization time was （13.5＋ 7.8）rain. The accuracy of finger palpation positioning lesions was 78.2% （43/55）;localized by MSCT-guided hook-wire for 55 patients,the accuracy was 100% （55/55）. The difference was statistically significant （χ^2 = 13.47, P〈0.01）. All cases were diagnosed by the postoperative pathological examination. Conclusion; Preoperative MSCT-guided hook-wire localization is safe and effective for VATS resection of SPN. It has the advantages of shortening the thoracoscopic resection time and reducing the rate of changing to thoraeotomy,thus possessing obvious clinical application value.