术前CT穿刺定位辅助电视胸腔镜手术治疗肺小结节的临床研究

Clinic study of CT-guided puncture localization for small solitary pulmonary nodules in video-assisted thoracoscopic surgery

目的:探讨CT引导穿刺术前定位辅助电视胸腔镜手术治疗孤立性肺小结节(SSPN)的临床价值。方法:对20例SSPN患者于术前行CT引导下带钩钢丝(Hook-wire)定位,然后行电视胸腔镜手术(VATS)。结果:术前CT穿刺定位成功率为100%,平均定位时间为(30.15±5.16)min。2例患者定位后发生微量气胸并发症,无须特殊处理。VATS楔形切除术成功率为100%。20例患者中16例术中快速冰冻切片病理诊断为原发性腺癌,继续行VATS肺叶切除加淋巴结清扫术;4例病理学检查为炎性肉芽肿。无一例中转开胸。结论:电视胸腔镜手术前CT引导下Hook-wire定位SSPN准确率高,并发症发生率低,是一种安全、有效的方法。

Objective： Clinic evalution of the efficacity and safety of preoperative CT-guided puncture localization for small solitary pulmonary nodules（ SSPN） in video-assisted thoracic surgery（ VATS）. Methods： 20 operative patients of SSPN were localizated under CT guided puncture with Hook-wire,and wedge resection was performed through VATS. Results： Preoperative CT-guided Hook-wire localization successed in all patients（100%）. The mean localization time was（30. 15 ± 5. 16） min. The complication was mild pneumothorax in 2 cases,but no case needed chest tube drainage. The nodules were removed by VATS in all patients. 16 cases were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection,and the VATS lobectomies were performed. Histological assessment revealed inflammatory disease in 4 patients. No case was converted into thoracotomy. Conclusion： The preoperative CT guided Hook-wire localization for SSPN is accurate in VATS. It is an effective and safe technique.