利用留尾微弹簧圈方法行肺结节胸腔镜前定位的研究

Leaving-tail microcoil localization for pulmonary nodules prior to thoracospy

目的描述CT引导下利用留尾微弹簧圈方法在胸腔镜手术切除(VATS)术前定位肺部小结节病灶的介入规范化操作流程。方法回顾性分析81位肺小结节患者行CT引导下微弹簧圈术前定位情况。根据肺小结节的所处部位,采用合适穿刺路径的体位。肺部穿刺定位采用病灶旁微弹簧圈置入方法,并将其尾部留于脏层胸膜以外,利用置入操作后CT图像测量定位微弹簧圈的深度,以及脏层胸膜外微弹簧圈留尾长度,并与VATS术中所见对比,记录定位相关并发症,评价定位情况。结果81例88个肺小结节病灶完成了CT引导下微弹簧圈术前定位。根据患者病灶位置选择穿刺路径及体位。定位后CT检查,胸膜距离微弹簧圈肺内前端的深度以及胸膜外留尾长度分别为(18.4±6.6)mm(2~36mm),(8.1±6.3)mm(-13~26mm)。VATS术中见79例(89.89,79/88)病灶的定位微弹簧圈前端在肺内固定,尾段于脏层胸膜以外。VATS成功切除术前定位的88例肺小结节病灶,定位操作均无严重并发症出现。结论根据肺部小结节所在部位,规范化的微弹簧圈置入方法是术前定位成功的关键。

Objective To describe standardized interventional protocols of CT-guided localizing pulmonary nodules with leaving-tail microcoil prior to video-assisted thoracoscopic surgical(VATS)resection.Methods This study retrospectively included 81 patients who underwent preoperative microcoils localization towards small pulmonary nodules.According to the location of pulmonary nodule,a proper patient’s position for microcoil implantation had been adopted.The head of microcoil was pinpointed adjacent to the target nodule while its end tail remained above the visceral pleura.After the implantation,CT scan was conducted to assess the depth of the microcoil and its length outside the pleura.The results of CT were compared with observation by VATS within 24 hours.The complications and success rate of implantation were recorded.Results CT-guided microcoil implantations targeting 88 pulmonary nodules were performed.The planning access route and implantation site were determined based on the location of the pulmonary nodule,and were followed by an appropriate body position on the CT table.After implantation,CT scan showed the intra-pulmonary depth and extra-pleural length of microcoil were(18.4±6.6)mm(2~36 mm),(8.1±6.3)mm(-13~26 mm),respectively.During VATS,localization microcoils from 79 cases(89.89,79/88)were visualized that their front-ends were partially inserted and their end tails remained above the visceral pleura.Finally,eighty-eight localizing pulmonary lesions were successfully resected by VATS and no serious complications occurred in the localization.Conclusion According to the location of lesion in the lungs,the standardized microcoil implantation method is the key to successful preoperative localization.