螺旋CT多平面重建技术对肺小结节术前定位的指导作用

Multi-Slice Spiral CT Multiplanar Reconstruction in the Localization of Pulmonary Nodules

目的探讨多层螺旋CT多平面重建（MPR）技术对肺小结节胸腔镜术前定位的指导作用。方法对准备胸腔镜（VATS）肺楔形切除的57例（62个肺小结节）患者行术前低剂量螺旋CT引导下亚甲蓝定位肺结节。常规引导组（简称非MPR组）39例,MPR引导组（简称MPR组）18例。对两组病灶到胸膜距离、穿刺次数、调整次数、穿刺用时、并发症发生率、手术耗时、平均剂量-长度积（DLP）、术中出血量、定位成功率的差异进行统计学分析。结果两组病灶到胸膜距离和进针次数比较无统计学意义（P〉0.05）。但两组穿刺调整次数和穿刺时间均有统计学意义（P〈0.05）,MPR组平均减少0.5次,缩短3.4 min。MPR组术后患者所接受的辐射剂量较非MPR组少40.13 m Gy·cm-1（P〈0.05）。MPR组的术后并发症发生率与非MPR相当（P〉0.05）,没有出现明显并发症。手术时间、出血量及定位成功率均未见明显统计学意义（P〉0.05）。结论多层螺旋CT MPR技术可直观显示穿刺定位路径,减少穿刺过程的调整次数和辐射,缩短操作时间,对肺结节VATS术前亚甲蓝定位有一定指导价值。

Objective To explore the guiding role of multi-slice spiral CT multiplanar reconstruction（ MPR） in preoperative thoracoscopic localization of pulmonary nodules. Methods Sixty-seven patients with pulmonary nodules were treated with VATS lung wedge resection. Low-dose spiral CT-guided methylene blue was used to localize lung nodules. There were 39 cases of non-MPR group and 18 cases of MPR group. The statistical analysis was made on the difference of the distance from the lesion to the pleura,the number of punctures,the number of times of adjustment,the time of puncture,complication rate,operation time,average dose-length product（ DLP,m Gy · cm-1）,intraoperative blood loss and positioning success rate. Results There was no significant difference between the two groups in the distance of pleura and the number of punctures（ P〈0. 05）. The number of puncture adjustments and puncture time in both groups were statistically significant（ P〈0. 05）,MPR group decreased 0. 5 times,shortened 3. 4 min. The radiation dose received by the MPR group was40. 13 m Gy·cm-1 less than that in the non-MPR group（ P〈0. 05）. The incidence of postoperative complications in the MPR group was similar to that in the non-MPR group（ P〈0. 05）. No significant complications were observed. Operation time,bleeding volume and the success rate of positioning were not statistically significant（ P〈0. 05）. Conclusion Multislice spiral CT MPR can directly display the puncture location path,reduce the adjustment times and radiation of the puncture process and shorten the operation time,which is helpful for the location of methylene blue before VATS.