CT引导下微弹簧圈定位在肺小结节胸腔镜术中的临床应用

The clinical application of CT-guided microcoil positioning of small pulmonary nodules in video-assisted thoracic surgery

目的探讨电视胸腔镜手术(VATS)前CT引导下微弹簧圈定位肺小结节(SPN)对精准切除病灶的临床价值。方法回顾性分析2014年6月至2016年5月,90例行VATS切除孤立性SPN患者的资料。其中45例患者术前行微弹簧圈定位(A组),45例患者未行术前定位(B组)。统计分析两组VATS肺叶楔形切除时间、转开胸手术率、术后住院时间,以及微弹簧圈定位病灶的成功率、并发症等,评价术前微弹簧圈定位病灶的安全性及其对VATS术的增益价值。结果 A组VATS术成功率100%;SPN病灶定位成功率95.6%,术后出现气胸5例、肺表面出血6例、弹簧圈脱落2例等并发症。B组VATS手术成功率84.4%,中转开胸率15.6%。A组VATS手术时间(17.7±2.8)min、术后住院时间(6.2±1.7)d及中转开胸0例明显低于B组,差异具有统计学意义(P<0.05)。结论 CT引导下微弹簧圈定位,可辅助VATS快速、精确切除肺内小病灶,能有效降低中转开胸率、缩短VATS手术时间及术后住院时间。

Objective To assess the clinical value of preoperative CT-guided microcoil positioning of small solitary pulmonary nodule （SPN） in assisting video-assisted thoracic surgery （VATS） procedure to more quickly and more precisely remove small pulmonary lesions. Methods The clinical data of 90 patients with SPN, who were admitted to authors＇ hospital during the period from June 2014 to May 2016 to receive VATS, were retrospective analyzed. Preoperative CT-guided microcoil positioning of SPN was employed in 45 patients （group A）, while other 45 patients （group B） did not receive preoperative positioning of SPN. The pulmonary lobar wedge resection time, the transfer rate of changing to open chest operation, postoperative hospitalization time, the success rate of microcoil positioning of SPN, complications, etc. of both groups were statistically analyzed. The safety of preoperative CT-guided microcoil positioning of SPN was evaluated, and its benefit-enhancing value for VATS was discussed. Results in group A, the success rate of VATS was 100% and the success rate of SPN positioning was 95.6%. Postoperative complications included pneumothorax （n=5）, pulmonary surface hemorrhage （n=6）, and dislodgement of microcoil （n=2）. In group B, the success rate of VATS was 84.4% and the transfer rate of changing to open chest operation was 15.6%. In group A, the manipulation time of VATS was （17.7±2.8） min, the postoperative hospitalization time was （6.2±1.7） days, and the transfer rate of changing to open chest operation was 0%, which were strikingly lower than those in group B; the differences between the two groups were statistically significant （P〈0.05）. Conclusion Preoperative CT-guided microcoil positioning of small SPN can assist VATS procedure to remove small pulmonary lesions more quickly and more precisely, it can effectively reduce the transfer rate of changing to open chest operation, shorten the manipulation time of VATS as well as the postoperative hospitalization time.（J Intervent Radiol, 2017, 26： 555-559）