术前CT引导下Hook-wire定位胸腔镜切除肺毛玻璃样结节临床研究

The clinical value of CT guidance Hook-wire positioning thoracoscopic surgery for ground-glass opacity lung nodules

目的:探讨CT引导下Hook-wire术前定位肺磨玻璃样结节(GGO)在胸腔镜切除术中的应用。方法:25例肺GGO患者均术前行Hook-wire定位,行胸腔镜肺楔形切除术。根据术中冰冻病理结果决定下一步治疗方式。结果:肺GGO直径为(11.48±3.50)mm,距离壁层胸膜(16.52±5.98)mm。CT引导肺GGO Hook-wire定位均成功,定位时间(15.04±3.38)min,出现微量气胸5例(占20%),均不需放置引流管,1例出现少许肺实质出血(占4.00%),无一例出现定位针脱落,实施胸腔镜肺楔形切除100%,其中12例单纯行胸腔镜肺楔形切除手术时间为(21.67±3.94)min,13例为浸润性腺癌,行胸腔镜肺叶或是肺段切除及淋巴结清扫术,手术时间为(58.84±12.01)min。结论:术前CT引导下Hook-wire定位是一种安全可靠且容易掌握的临床技术,降低了手术时间,并发症少,值得临床推广应用。

Objective： To evaluate the clinical application of guidance Hook-wire positioning for ground- glass opacity before video-assisted thoracoscopic resection. Methods： Preoperative location of 25 patients with ground-glass opacity lung nodules was performed using CT-guided Hook-wire technique. Video assisted thoracic surgery （VATS） pulmonary wedge resection was adopted. According to the result of intraoperative frozen pathology, the next mode of operation was adopted. Results： GGO diameter （11.48±3.50） mm, diatance from the parietal pleura （16.52±5.98） mm. Twenty five patients were successfully located. The mean procedure time for preoperative CT-guided Hook-wire location was （15.04±3.38） min. 5 patients had micro pnemnothroax after positioning. The chest tube drainage was not required. One patient had minimal needle tract parenchymal hemorrhages. No one occured migration and fall out of the hookwire. VATS wedge resection surgery successful rate was 100%. Twelve cases of pure thoracoscopy pulmonary wedge resection operation time was （21.67±3.94） min. Thirteen patients were diagnosed as infiltrating adenocarcinoma of the lung. All of them underwent lobectomy or lung resection and lymph node cleaning by VATS. The mean procedure duration for VATS was （58.84±12.01） rain. Conelution： CT-guided Hook-wire fixtion is safe, reliable and easy to learn clinical techniques. It reduces the operation time, and has a low rate of a minor complictions. CT-guided Hook-wire fixtion is worthy of clinical popularization and application.