CT引导下Hookwire定位孤立性肺结节的临床应用及并发症分析

Analysis of clinical application and complications of Computed Tomography Guided Hookwire localization of solitary pulmonary nodules

目的探讨CT引导下Hookwire定位孤立性肺结节(solitary pulmonary nodules SPNs)行电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)的临床价值及并发症发生的高危因素。方法回顾性分析84例患者88枚直径≤2cm的SPNs,在CT引导下Hookwire定位并VATS切除的临床资料,统计分析定位成功率、并发症、病理结果及定位操作相关数据等,对影响并发症的因素采用单因素分析及Logistic回归分析。结果共84例患者88枚SPNs(男性36例,女性48例),定位时间平均14.8±3.6min(8-38min);19例患者出现穿刺相关并发症,包括7例微量气胸,5例肺周血肿,4例合并出现微量气胸及肺周血肿,3例脱钩,全组无咯血、空气栓塞及血胸发生,并发症发生率22.6%(19/84);手术时间平均22.2±4.3min(15-50min),术中出血量平均20.3±3.7ml(10-50ml);3例脱钩者均在术中找到脏层胸膜穿刺出血点后成功切除病灶,全组无中转开胸,其中单纯楔形切除57例,楔形+肺叶切除27例;术后病理良性病灶30枚,癌前病变8枚,恶性病灶50枚;单因素分析显示肺部疾病史、结节与胸膜的距离、穿刺时间、进针角度及进针深度对并发症发生有显著影响(P<0.05);多因素Logistic回归分析提示肺部疾病史(OR=11.744;p=0.002)、穿刺时间(OR=8.472;P=0.006)、进针深度(OR=15.695;P=0.006)是并发症发生的独立危险因素。结论术前CT引导下Hookwire定位并VATS切除术是一种安全、高效的诊断及治疗SPNs方法;肺部疾病史、穿刺时间、进针深度是并发症发生的独立危险因素。

Objective To investigate the clinical application value of computed tomography （CT） guided Hookwire localization of solitary pulmonary nodules （SPNs） in video assisted thoracoscopic surgery （VATS） and the risk factors related to complications. Methods We retrospectively analysed clinical data of 84 patients with 88 pul- monary nodules（diameter≤2cm） who had undergone CT guided hookwire localization before VATS. The localization achievement ratio, complication rate, pathologic results and technical details were assessed. Univariate analysis and logistic regression were used to evaluate the association between factors and complications. Result Eighty-four con- secutive patients （36 men and 48 women） underwent CT guided Hookwire localization with 88 pulmonary nodules. The mean procedure time of CT-guided localization was 14. 8±3. 6min （8 - 38 min）. The positioning success rate was 96. 6%. The dislocation of Hook-wire was found in three patients during the VATS, but the lesions were still suc- cessfully resected by finding visceral pleura puncture bleeding spot. Complications after localization occurred in 19 patients （22. 6% ）, 7 with asymptomatic pneumothorax, 5 with asymptomatic pulmonary hematoma, 4 with simulta- neous pneumothorax and pulmonary hematoma,3 with intraoperative dislodgement. There were no hemoptysis, air em- bolism and hemothorax occurred. Mean procedure time for VATS wedge resection was 22. 2±4. 3 minutes （ 15 - 50min）, and mean blood loss was 20. 3±3.7ml （10 -50ml）. No patient was converted to thoracotomy, 57 cases with simple wedge resection, 27 cases with wedge resection and lobectomy. Results of pathological examination re- vealed 30 benign lesions, 8 precancerous lesions and 50 malignant lesions. An univariate analysis showed that these factors including pulmonary disease history , nodule from pleural distance, time of puncture, angle of needle insertion and depth of insertion were associated with complications （ P 〈 0.05 ）, whereas pulmonary disease history （ OR = 11. 744 ; P = 0. 002 ） , time of puncture （ OR = 8.472 ; P = 0. 006 ）, and depth of insertion （ OR = 15. 695 ; P = 0. 006 ） were independent risk factors using logistic regression analysis. Conclusion CT guided Hookwire localization can be an effective and safe procedure prior to VATS, enabling accurate resection and diagnosis of small pulmonary nodules. The pulmonary disease history, time of puncture and depth of insertion were independent risk factors of complication caused by CT guided Hookwire localization.