术前CT引导下Hookwire定位联合胸腔镜肺段切除术治疗孤立性肺结节应用研究

Combined application of preoperative CT-guidedHookwire localization and thoracoscopic pulmonary segmentectomy in patients with solitary pulmonary nodule

目的 分析术前计算机断层扫描(CT)引导下Hookwire定位联合胸腔镜肺段切除术治疗孤立性肺结节(SPN)的临床应用价值。方法 于2018年1月至2019年3月,采用术前CT引导下Hookwire定位联合胸腔镜肺段切除术治疗该院收治的SPN患者32例。分析定位准确率、定位并发症、电视胸腔镜手术(VATS)肺段切除成功率、SPN病理分型等资料。结果 SPN直径(8.68±2.78)mm,病灶边缘距胸膜(17.78±3.06)mm,穿刺定位时间(24.31±4.43)min。5例患者定位后CT扫描发现微量气胸。32例患者定位及手术成功。手术时间(170.62±41.65)min,术后住院时间(6.21±2.12)d,术后无严重并发症。术后组织病理学确诊非典型腺瘤样增生12例、原位腺癌5例、微浸润性腺癌6例,良性病变9例。结论 术前CT引导下Hookwire定位联合胸腔镜肺段切除术能准确进行SPN穿刺定位及切除,具有可行性和安全性,值得推广应用。

Objective To explore the feasibility and safety of preoperative CT-guided Hookwire localization and thoracoscopic pulmonary segmentectomy(TPS)in patients with solitary pulmonary nodule(SPN).Methods From Jan.2018 to Mar.2019,32 patients with SPN were treated with preoperative CT-guided Hookwire localization and TPS.Positioning accuracy,complications,successful rate of TPS,SPN pathological classification and other indicators were analyzed.Results SPN diameter was(8.68±2.78)mm,and distance from focus to parietal pleura was(17.78±3.06)mm.The procedure time for preoperative CT-guided Hookwire localization was(24.31±4.43)min.Five patients had micro pneumothroax after localization.The duration of surgery was(170.62±41.65)min,the postoperative hospital stay was(6.21±2.12)d.No severe complications occurred in all patients.Postoperative pathology indicated 12 cases with atypical adenomatous hyperplasia,5 cases with adenocarcinoma in situ,6 cases with minimally invasive adenocarcinoma,9 cases with benign lesions.Conclusion Combined application of preoperative CT-guided Hookwire localization and TPS could be feasible and safe for the localization and surgical resection of SPN.