术前CT引导下Hook—wire定位肺部磨玻璃样结节在胸腔镜肺切除术中的临床研究

目的探讨术前CT引导THook-wire定位在肺部磨玻璃样结节（GGO）切除术中的临床应用价值。方法2015年1月至7月共23例肺部GGO患者，29个GGO病灶，行胸腔镜下（VATS）切除术，术前皆在CT引导下行Hook-wire定位，记录术前CT引导下Hook—wire定位的时间、成功率、并发症、转行肺叶切除率、中转开胸率、术后住院时间、组织病理分型等，探讨术前CT引导下Hook-wire定位在〈10mm肺部GGO行胸腔镜下切除术的临床应用价值。结果共23例患者（男4例，女19例）的29枚GGO行VATS下切除。其中，行楔形切除2l例（2例因浸润性腺癌进一步行肺叶切除），2例因术中Hook—wire脱钩转行肺叶切除，无中转开胸病例；病灶直径（6，44±1．33）mm，距离胸膜（12．23±6．20）mm；术前CTqf导下Hook—wire定位成功率100％（2例术中发现Hook．wire脱钩）；严重并发症发生率O％，转肺叶切除率8．7％（2例）；转开胸手术率0％；CT定位时间（13．57±7．06）rain；行肺楔形切除时间（20．74±10．48）min；术后住院时间（6．57±2．31）d；术后病理分型：原位腺癌13枚，微浸润腺癌10枚，浸润性腺癌2枚，炎性痛灶2杖，胶原结节2杖。结论肺部GGO具有较高恶性率，对典型患者行积极的手术治疗是必要的，对于绝大多数原位腺癌及微浸润腺癌病例，单纯行楔形切除是有效的。术前CTql导下Hook-wire定位技术明显提高了VATS下行楔形切除的可行性，并发症发生率低，具有较好的临床使用价值。

Objective To evaluate the value of preoperative computed tomography （ CT ） -guide localization using a hook-wire placement for small pulmonary ground-glass opacity （ GGO ） in minimally invasive operation resection. Methods We retrospectively analyzed 29 hook-wire placement for 23 patients from Jan 2015 to July 2015 in our hospital. All patients received preoperative CT-guide hook-wire localization. The efficacy of preoperative localization was evaluated in terms of procedure time, VATS success rate, duration of operation, associated complications, conversion lobeetomy rate, conversion thoracotomy rate, postoperative hospital stay and histology of GGOs. Results A total of 23 patients （ 4 males and 19 females ） underwent 29 VATS resections, 21 cases underwent wedge resection （ 2 cases further to lobectomy for invasive adenocarcinoma ） , 2 cases conversion lobeetomy due to intraoperative hook-wire decoupling, no thoracotomy case. Lesions diameter was （ 6.44 ± 1.33 ） mm, the distance of lesions to pleural was （ 12.23 ＋ 6.20 ） mm, all CT-guided Hook-wire localization successful rate was 100%, no severe complications. The procedure time for CT-guided hook-wire localization was （ 13.57 ± 7.06 ） min, procedure time for VATS wedge resection was （ 20.74 ± 10.48 ） min, postoperative hospital stay was （ 6.57 ± 2.31 ） d. Results of histology revealed 13 adenocarcinoma in situ （ AIS ） , 10 minimally invasive adenocarcinoma （ MIA ） , 2 invasive adenocareinoma, 2 inflammatory lesions, 2 collagen nodules. Conclusion Lung GGOs carry a high risk of malignancy. Aggressive surgical resection of these GGOs is necessary and feasible. For the vast majority of AIS and MIA, wedge resection may be effective. CT-guided hook-wire localization has greatly improved the feasibility of VATS wedge resection, and the incidence of complications is low, which has a good clinical value.