肺部单纯磨玻璃样结节术前CT引导下钡剂悬液定位的临床研究

A clinical research on pure ground-glass pulmonary nodules preoperative CT-guided localization of barium suspension

目的 探讨肺部单纯磨玻璃样结节（pGGO）术前CT引导下钡剂悬液定位的应用价值.方法 选择27例pGGO患者（共29个）,行CT引导下穿刺硫酸钡悬液定位,后行全胸腔镜下肺部楔形切除术,若术中快速病理为恶性结节则行完全胸腔镜肺叶切除加淋巴结清扫术.观察并统计定位成功率、定位时间、定位并发症、中转开胸率及肺楔形切除时间等.结果 27例患者的29个pGGO在CT引导下钡剂悬液定位成功率为100％（29/29）,定位时间（23.25±8.12） min.定位完成后2～24h（平均14.2 h）患者无明显疼痛不适;少量气胸3例,无需外科处理;少量咯血1例;胸膜反应2例,无血胸或血气胸,无空气栓塞.术中病灶手指均能探查,且X线透视均能显示定位,病灶行全胸腔镜下楔形切除,无中转开胸探查,标本切缘距病灶距离＞ 10mm.电视胸腔镜手术肺楔形切除时间（15.45±7.32） min,术中失血量（46.11±8.91） ml,住院时间（7.20±3.12）d.所有患者均明确诊断.结论 pGGO全胸腔镜术前CT引导下钡剂悬液定位准确、安全、经济、方便.

Objective To investigate the application value of the pure ground-glass pulmonary nodules （pGGO） preoperative CT-guided localization of barium suspension.Methods Twenty-seven patients with pGGO （29 nodules） underwent CT-guided needle localization of barium sulfate suspension,underwent full thomcoscopic pulmonary wedge resection,intraopemtive rapid pathological if malignant nodules the line completely thoracoscopic lobectomy plus lymph node dissoction.The success rate of localization,localization time,localization complications,conversion to thoracotomy rate and pulmonary wedge resection time were observed and counted.Results Twenty-seven patients of 29 pGGO CT-guided localization of barium suspension with 100％ （29/29） success rate,the localization time was （23.25 ± 8.12）min.Postoperative complications：2-24 hours （average 14.2 hours） after localization was completed in patients with no obvious pain and discomfort,a small pneumothorax 3 cases without surgical treatment,a small amount of hemoptysis in 1 case,pleural reaction 2 cases,no hemothorax or pneumothorax,no air embolism.Intmoperative lesions finger can probe and X-ray can show location,lesions were totally thoracoscopic wedge resection,no transit thoracotomy,specimen edge distance away from the lesions ＞ 10mm.VATS wedge resection operation time was （15.45 ±7.32） min,intraoperative blood loss was （46.11 ±8.91） ml,hospitalization time was （7.20 ± 3.12） d.All patients were diagnosed.Conclusion Barium suspension thoracoscopic preoperative localization of pulmonary nodules under CT-guidance is accurate,safe,economical and convenient.