CT引导下Hook-wire定位对早期肺癌术后复发率的影响

Effect of CT-guided localization with a Hook-wire system on postoperative recurrence for early lung cancer

目的探讨胸腔镜术前CT引导下Hook-wire不同定位方式,对Ⅰ期肺癌切除术后复发率的影响。方法 2010年1月至2013年12月,我院共收治了147例肺部孤立性小结节(solitary pulmonary nodule,SPN)或磨玻璃样病变(ground-glass opacity,GGO)。经过删选后共有125例患者纳入研究,其中SPN 81例,GGO 44例,所有患者胸腔镜手术前均行Hook-wire定位,68例患者接受Hook-wire穿刺针穿过病灶,57例贴近病灶定位于周围正常肺组织中。根据手术结果,评价Hook-wire不同定位方式定位的效果,对早期肺癌术后复发的影响,使用Logistic回归分析早期肺癌经Hook-wire定位切除术后复发的危险因素。结果 125例患者术前平均定位时间为(20±8)min,3例出现导丝脱落(2.4%),无症状并发症78例。所有患者均行胸腔镜下手术治疗,12例由于胸腔粘连中转开胸,术后病理:原发性肺癌76例,良性病变44例,5例为转移性肿瘤。原发性肺癌患者中,Hook-wire定位穿过病灶40例,贴近病灶定位36例,术后9例复发,前者复发率明显高于后者(20%vs 2.8%,P=0.031)。单因素和多因素Logistic回归分析显示,亚肺叶切除、病理为腺癌、Hook-wire穿过病灶定位、术前穿刺出血是术后复发的独立危险因素,术后辅助化疗为保护性因素。结论胸腔镜术前早期肺癌经CT引导下Hook-wire定位,穿过病灶定位的术后复发率高于贴近病灶定位,对于直径≤2.0 cm的早期肺癌,选择亚肺叶切除术需谨慎。

Objective To evaluate the effectiveness of different CT-guided localization with a Hook-wire system prior to video-assisted thoracoscopic surgery （VATS） on postoperative recurrence for 1 stage lung cancer. Methods From January 2010 to December 2013, 147 patients with solitary pulmonary nodule （SPN） or ground glass opacity （GGO） was admitted to our hospital. A total of 125 patients was enrolled into the study after clear screen. CT- guided localization with a Hook-wire system was used before VATS in all patients, including 68 patients with Hookwire needle through the lesions and 57 patients with needle close to the lesions located in the surrounding normal lung tissue. On the basis of surgery results, the effect of different CT-guided localization with Hook-wire system was estimated, the effect on postoperative recurrence was also evaluated, and the risk factors of lung cancer recurrence after localization with a Hook-wire system was illustrated by Logistic regression analysis. Results The mean preoperative localization time of 125 patients was（ 20 ± 8 ）min, and localization failure was found in 3 cases due to guide wire slipping. There were 78 cases of complication without symptoms. All patients underwent VATS for their disease, excluding 12 patients because of thoracic cavity adhesion and they received thoracotomy. After pathological examinations, there were 76 lung cancer, 44 benign lesions, and 5 metastatic tumors. Among the 76 patients with lung cancer, 40 patients with Hook-wire needle through the lesions and 36 patients with needle close to the lesions. Nine patients suf fered cancer recurrence, and the rate was higher for patients in the former group than in the latter group （20% vs 2. 8%, P =0. 031 ）. Univariate and multivariate logistic regression analysis showed sub-lobar resection, adenocarci- noma, Hook-wire needle through the lesions, and bleeding during localization were independent risk factors for lung cancer recurrence. However, adjuvant chemotherapy was protective factor. Conclusion CT guided localization for early lung cancer with Hook-wire system is prior to VATS. The postoperative cancer recurrent rate is higher in patients with needle through the lesions than close to the lesions. For patients of early lung cancer with diameter ≤2. 0 cm, sub-lobar resection should be conducted with great cautions.