CT引导下穿刺定位联合单操作孔胸腔镜切除肺磨玻璃密度微小结节的临床研究

Clinic research of CT guided localization with a hook-wire system for small ground glass opacity pulmonary nodules united with single port video-assisted thoracoscopic resection

目的评价术中应用CT引导下穿刺定位后行单操作孔胸腔镜切除CT病灶直径＜1.5 cm且胸膜无明显改变的磨玻璃样小结节的临床效果。方法2009年8月至2014年9月共15例肺磨玻璃样小结节患者，手术室内麻醉、体位固定后行术中CT引导下带钩钢丝针穿刺定位，随即行胸腔镜切除术。评价术中CT引导下穿刺定位技术的准确性、并发症、单操作孔胸腔镜手术切除率及病理结果等。结果15个磨玻璃样小结节均在术中CT引导下穿刺定位明确并行单操作孔胸腔镜切除术。术中CT定位成功率100%，平均定位时间（13.60±2.06）min，仅1例穿刺后出现少量气胸。单操作孔胸腔镜手术切除率为100%，其中肺叶切除1例，肺段切除1例，局部切除13例。术后病理诊断结果：原位腺癌9例，不典型腺瘤样增生（AAH）5例，AAH合并原位腺癌1例。术后随访患者均存活，无复发、转移征象。结论术中麻醉下应用CT引导能准确将CT直径＜1.5 cm且胸膜无明显改变的磨玻璃样小结节行穿刺定位，并能联合单操作孔胸腔镜将其切除，准确、快捷、安全，具有很好的临床价值。

ObjectiveTo evaluate the clinical effect of CT guided localization with a hookwire system united with single port videoassisted thoracoscopic resection （VATS） for small ground glass opacity （GGO） pulmonary nodules （CT lesion diameter〈1.5 cm and no pleural changes）. MethodsFifteen patients with small GGO pulmonary nodules who underwent CTguided transthoracic localization with a hookwire system in operation room after anesthesia were performed with single port VATS from August 2009 to March 2013. The accuracy of puncture location, complications, resection rate and pathological results were evaluated. ResultsAll patients underwent CTguided hookwire localization and single port VATS resection. The success rate of localization was 100%, and the average procedure time was （13.60±2.06）min, only 1 patient occurred minimal pneumothorax. The resection rate of single port VATS was 100%, and lobectomy performed in 1 patient, segmentectomy in 1, and local resection in 13. Pathological diagnosis： adenocarcinoma in situ in 9, atypical adenomatous hyperplasia （AAH） in 5, AAH and adenocarcinoma in situ in 1. Postoperation followup showed all patients survived, and no recurrence and metastasis. ConclusionIn operation, use of CT guided localization with a hookwire system for small GGO pulmonary nodules （CT lesion diameter〈1.5 cm and no pleural changes） united with videoassisted thoracoscopic resection is accurate, quick and safe, and it has good clinical value.