孤立性肺小结节术前CT引导下染色定位的临床应用

Application of preoperative CT methylxanthine chloridein treatment of small pulmonarynodule patients with thoracoscopy

目的:探讨CT引导下亚甲蓝染色定位在胸腔镜肺叶楔形切除治疗孤立性肺小结节中的临床应用。方法:选取2015年1月—2016年1月心胸外科收治的25例患者,先在CT引导下对28枚小结节行亚甲蓝定位,后行胸腔镜肺叶楔形切除治疗,统计定位时间、成功率、并发症、手术成功率等情况。结果:25例患者孤立性肺小结节直径为(10.26±5.58)mm,距壁层胸膜(11.06±8.22)mm。28枚孤立性肺小结节在CT引导下行亚甲蓝定位,1例失败,成功率96%,定位时间为(22.60±4.86)min,手术时间为(18.02±4.45)min。患者定位后发生少量气胸4例(16%),少量咯血1例(4%),胸膜反应2例(8%),经对症处理均好转,未出现血胸、血气胸、肺血管气栓等严重不良反应。28枚小结节病理结果提示:12枚(42.9%)患者快速病理证实为恶性,16枚为良性病变。结论:采用亚甲蓝在CT引导下对肺小结节进行染色定位,为胸腔镜肺叶楔形切除提供准确定位,具有操作简单、定位精确、价格便宜、材料容易取得等优势,可以相应地缩短时间,提高胸腔镜肺叶楔形切除术的成功率。

Objective：To evaluate the CT-guided positioning of methylene blue staining wedga-shape excision of lung of solitary pulmonary nodules clinical application.Methods：From January 2015 to January 2016 in hospital 25 patients treated by thoracic surgery,the first under CT guidance of 28 small nodules positioned methylene blue,underwent lobectomy,positioning time statistics,the success rate,complications,success rate and so on.Results：The group of 25 patients with solitary pulmonary nodule diameter of （10.26±5.58） mm,from the parietal pleura （11.06±8.22） mm.28 solitary pulmonary nodules in CT-guided positioning of methylene blue,1 case of failure,the success rate of 96%,positioning time of （22.60±4.86） min,operative time was （18.02±4.45）.A small amount of pneumothorax four 4 cases （16%） occurred in all patients after locating a small amount of hemoptysis in 1 case （4%）,pleural reaction in 2 cases （8%）,There is no blood chest,blood pneumothorax,pulmonary vascular thrombosis,the symptomatic treatment are improveddoes not appear no hemothorax,pneumothorax,pulmonary vascular air embolism,etc,symptomatic handling were improved.28 small nodules pathology results suggest that 12 cases （42.9%） patients with pathologically confirmed malignant fast,16 benign lesions.Conclusion：The use of methylene blue in the CT-guided pulmonary nodules for staining and positioning for the thoracic lobe wedge resection （VATS） to provide accurate positioning,with simple operation,accurate positioning,cheap,easy access to materials and other advantages,can be shortened accordingly time to increase wedga-shape excision of lung success rate.