胸腔镜在肺部微小结节诊治中的应用

Applications of Video-assisted Thoracic Surgery for the Diagnosis and Treatment of Patients with Small Pulmonary Nodules

背景与目的随着胸部CT的应用推广,孤立性肺结节的出现逐渐增多,尤其是胸部薄层高分辨CT的检查,检出直径10 mm以下的微小结节的概率增高,临床上对于如何诊治这类微小结节仍存在较大争议。本研究旨在探讨胸腔镜手术在肺部微小结节的诊断和治疗中的价值。方法 2009年11月-2012年5月,对64例肺微结节应用电视胸腔镜手术先行肺结节楔形切除,术前均无明确病理诊断,术中送快速冰冻病理检查,根据病理结果综合考虑后决定手术方式。结果原发性肺癌行全胸腔镜肺叶切除+淋巴结清扫20例;行肺楔形切除44例,其中良性肿瘤21例、癌前病变18例、转移癌3例、不适合肺叶切除的原发性肺癌2例。所有患者均明确病理诊断,确诊率100%。全组患者手术顺利,无严重手术并发症和围手术期死亡。结论肺部微小结节影像学诊断有一定难度;胸腔镜手术诊治肺部微小结节创伤小、诊断准确,具有重要的诊断意义。术前CT引导的hook-wire定位可帮助手术中探查病变部位。

Background and objective Chest computed tomography （CT）, particularly thin-slice high resolution CT, has low sensitivity and specificity for detecting pulmonary nodules 〈 10 mm in size. This limitation leads to challenges in clinical diagnosis and treatment of small pulmonary nodules. This study introduces the use of video-assisted thoracoscopic surgery （VATS） for the diagnosis and treatment of small pulmonary nodules. Methods From November 2009 to May 2012, 64 patients with small pulmonary nodules without prior preoperative pathologic diagnosis were treated by pulmonary wedge resection through VATS. The diagnosis of small pulmonary nodules was established from rapid frozen section. The type of operation depends on the pathology and the condition of the patients. Twenty patients with primary lung cancer were subjected to lobectomy and radical resection of the lymph nodes by complete thoracospic lobectomy or video-assisted thoracoscopic invasive lobectomy. Pulmonary wedge resection was performed in 44 patients, among whom 21 have benign nodule, 18 have precancerous lesion, 3 have metastatic nodule, and 2 have primary lung cancer for which lobectomy was not fit. Results Con- firmative diagnosis is difficult to obtain among patients with small pulmonary nodules. VATS is effective in the diagnosis and treatment of small pulmonary nodules. With VATS, patients with benign small pulmonary nodules can be cured, and patients with primary lung cancer can receive definite diagnosis and effective treatment in time. Conclusion CT-guided hook-wire fixation is useful in precise lesion localization for surgical resection.