CT引导下带钩钢丝定位行肺部磨玻璃影结节全腔镜下肺切除术28例分析

Application of preoperative CT-guided Hook-wire localization of pulmonary nodules in thoracoscopic lobectomy of lung

目的 探讨术前CT引导下Hook-wire定位在全腔镜下肺部磨玻璃影（GGO）结节切除术中的效果及可行性.方法 2008年12月至2013年12月我科收治的胸部CT检查发现肺部GGO或含GGO成分结节的患者共28例（31个GGO结节）,均于术前先行CT引导下带钩钢丝（Hook-wire）定位,再行全胸腔镜下肺部病灶楔形切除治疗,对术中快速冰冻病理检查为恶性GGO结节行肺叶切除术,记录Hook-wire定位情况的相关指标及楔形切除时间、操作中并发症等.28例中,男性17例、女性11例,平均年龄55岁.结果 28例患者31个GGO结节均完成CT引导下Hook-wire定位及全腔镜下手术治疗.31个GGO结节中,恶性结节19个（18例）,良性结节12个（10例）,结节平均大小为（1.8 ±0.6）cm,平均厚度为（1.2±0.4）cm,结节距胸膜垂直距离为（1.5±0.7）cm;CT引导下Hook-wire平均定位时间为（16.5±5.2）min,平均进针深度为（2.5 ±0.9）cm,29枚（26例）穿透结节,2枚（2例）未穿透结节（紧靠结节边缘）,操作中出现气胸者2例,均不需手术治疗.全部28例患者均进行了全胸腔镜下手术切除,平均楔形切除手术时间为（18.5±5.5）min,平均肺叶切除时间为（54.7±12.5）min.18例患者（19个GGO结节）术中冰冻示恶性肿瘤,16例继续接受肺叶切除术加淋巴结清扫术,1例患者因身体无法耐受、1例因两个肺叶GGO病灶为恶性而未行肺叶切除术,围手术期无明显手术并发症.术后GGO病理结果：腺癌9枚,细支气管肺泡癌10枚,不典型腺瘤样增生5枚,上皮样血管内皮瘤2枚,慢性炎症2枚,错构瘤1枚,炎性假瘤1枚,结节病1枚.术后平均住院时间为（6.6±1.9）d.结论 全腔镜下肺部GGO切除术前行CT引导下Hook-wire定位技术具有可行性良好、安全性较高、并发症少等优点,能够有效简化腔镜手术操作难度和时间.

Objective To evaluate the application of preoperative CT-guided Hook-wire localization of pulmonary nodules in thoracoscopic lobectomy of lung.Method Twenty eight patients with 31 pulmonary nodules of ground-glass opacity （GGO） detected by CT scan were admitted in our hospital from December 2008 to December 2013,including 17 males and 11 females with an average age of 55.The lesions were located by CT-guided Hook-wire technique,and lobectomy plus lymphadenectomy or pulmonary wedge resection were performed according to the results of fast frozen pathology.The characteristics of pulmonary nodules and general condition of the patients were analyzed.Results Among 31 nodules,19 were malignant and 12 benign with an average size of （1.8 ± 0.6） cm and thickness of （1.2-± 0.4） cm.The vertical distance from pleural to nodules was （1.5 ± 0.7） cm and the insert depth of needle was （2.5 ± 0.9） cm.The time for CT-guided Hook-wire localization was （16.5 ± 5.2） min.The operation time for pulmonary wedge resection and pulmonary lobectomy was （18.5 ± 5.5） min and （54.7 ± 12.5） min,respectively.Intraoperative frozen section showed malignant tumors in 18 patients （19 GGO nodules）,lobectomy plus lymphadenectomy were performed in 16 cases; 2 patients did not undergo pulmonary lobectomy because of poor physical condition or 2 GGO nodules in different lobes.There were no operation complications in this series.Postoperative pathologic findings of 31 nodules showed 9 cases of adenocarcinoma,10 bronchioloalveolar carcinoma,5 atypical adenomatous hyperplasia,2 epithelioid hemangioendothelioma,2 chronic inflammation,1 hamartoma,1 inflammatory pseudotumor and 1 sarcoidosis.The average postoperative hospital stay was （6.6 ± 1.9） days.Conclusions Endoscopic resection of pulmonary GGO nodules with CT-guided Hook-wire localization technique is feasible and safe,with less complications and less time consuming.