术前CT指标对全胸腔镜肺叶切除手术中转开胸的预测价值

The Predictive Value of Preoperative CT Index in the Conversion of Total Thoracoscopic Lobectomy to Thoracotomy

目的 探索术前CT指标与全胸腔镜肺叶切除手术中转开胸之间的关系,为临床医生更精确地选择适合全胸腔镜肺叶切除手术的病例提供影像学依据。方法 收集2016年6月至2018年10月期间在昆明医科大学第三附属医院行全胸腔镜肺叶切除手术的病例54例,回顾其术前CT资料并对CT指标进行分级,分析相关指标级别与是否实施中转开胸之间的关系。结果 共收集54例肺叶切除病例,其中38例施行了全胸腔镜肺叶切除术,16例施行了中转手术。全胸腔镜手术组与中转开胸手术组患者的年龄均值有统计学差异(P =0.047),中转组患者平均年龄较大。2组患者的性别及术后病理分布差异无统计学意义(P值分别为0.694、0.987)。2组患者术前CT指标中,病灶位置、肺门及纵隔淋巴结大小、肺门纵隔淋巴结钙化情况及胸膜增厚程度差异有统计学意义(P值分别为0.029、0.001、0.002、0.029),中转组术前CT显示病灶位于肺野中内带者较多,肺门、纵隔淋巴结较大,肺门纵隔淋巴结钙化出现率较高,胸膜增厚程度较重;而两组病灶的最大径差异无统计学意义(P值为0.817)。结论 拟行胸腔镜肺叶切除手术的患者,如果年龄较大,病灶靠近肺门,肺门及纵隔淋巴结明显肿大或伴有钙化,或术前CT显示胸膜较广泛增厚,则术中中转开胸的几率增高,这类患者可首先考虑胸腔镜辅助小切口手术或常规开胸手术。而患者的性别、病灶的性质及5 cm范围内病灶的大小对中转开胸没有预测作用。

Objective To explore the relationship between preoperative CT indicators and conversion in video-assisted thoracoscopic lobectomy surgery and to provide imaging basis for clinicians to make more accurate choices of the cases for VATS lobectomy surgery. Methods We collected 54 cases who underwent VATS lobectomy surgery in the third affiliated hospital of Kunming medical university during June 2016-October 2018, the preoperative CT data were retrospectively analyzed and relevant CT indicators were graded. The relationship between the grading of relevant CT indicators and the conversion rate was analyzed. Results 54 cases were enrolled, including 38 cases that accepted completed VATS lobectomy and 16 cases that were transferred into VAMT or OPEN surgery. There was statistically significant difference in the mean age of patients between VATS group and the converted VATS group(P = 0.047). Patients in the converted VATS group were older. The gender composition and postoperative pathological feature were similar between the two groups ( P = 0.694, 0.987, respectively). The converted VATS group had significantly higher grading in lesion location,peri-bronchial lymph nodes enlargement, peri-bronchial lymph node calcification and pleural thickening than the completed VATS group(P = 0.029, 0.001, 0.002, 0.029, respectively). The grading of tumor size was not significantly different between the completed and converted VATS groups(P = 0.817). Conclusions Older patients with lesions near to the hilum, peri-bronchial lymph node enlargement, peri-bronchial lymph node calcification,and extensive pleural thickening have higher conversion rate in VATS surgery. It is reasonable to attempt a thoracoscopic approach in patients without these preoperative patient and image characteristics.