CT引导下穿刺注射医用胶精准定位肺内异物的实验研究

Experimental study of precisely locating foreign body in the lung by CT-guided puncture injection of medical glue

目的建立CT辅助下肺内置入金属导丝模拟巴马小型猪肺内异物的模型,探索该模型用于研究CT引导下穿刺注射医用胶精准定位肺内异物后行胸腔镜下肺内异物取出术的可行性及安全性。方法选取4只巴马小型猪,麻醉后CT引导下在巴马小型猪的右侧肺内置入2 cm金属导丝模拟肺内异物。CT扫描确定异物位置后穿刺注射医用胶精准定位肺内异物,然后行胸腔镜下肺内异物取出术。结果 4只巴马小型猪均成功建立CT辅助定位肺内置入金属导丝模拟肺内异物的模型,操作时间6~9 min,平均(7.50±1.29)min;均CT引导下穿刺注射医用胶,定位操作时间18~25 min,平均(21.25±2.99)min;定位后出现气胸1只(25%),气胸量较小,未行处理,无血胸、肺栓塞等其他并发症。均完成胸腔镜下肺内异物取出术,手术时间46~93 min,平均(66.00±20.12)min;其中术中确定异物位置时间7~11 min,平均(8.75±1.71)min;解剖证实切开离体猪肺后,医用胶胶团位于肺内异物旁,胶团直径大小8~12 mm,平均(9.50±1.91)mm;胶团与肺内异物的距离9~13 mm,平均(11.00±1.83)mm;定位成功率为100%。结论建立CT辅助定位肺内置入金属导丝模拟巴马小型猪肺内异物的模型,证实了该模型用于研究CT引导下穿刺注射医用胶精准定位异物、实施胸腔镜下肺内异物取出术是安全、可行的,为进一步临床应用奠定了基础。

Objective To establish a model of CT-assisted foreign bodies in lungs of Bama miniature pigs with built-in metal guidewire, and explore the model to study the feasibility and safety of medical glue to accurately locate foreign bodies in the lungs by CT-guided puncture injection after thoracoscopic removal of foreign bodies in the lungs. Methods Four Bama miniature pigs were selected, and 2 cm metal guidewire was inserted into the right lung of Bama mini pigs under CT guidance after anesthesia to simulate foreign bodies in the lungs. After using CT scan to determine the location of the foreign body, puncture and injection of medical glue was used to accurately locate the foreign body in the lung, and then the thoracoscopic removal of the foreign body in the lung was performed. Results Four Bama miniature pigs successfully established CT-assisted models for simulating foreign bodies in the lung with metal guidewire embedded in the lungs. The operation time was 6-9 minutes, with an average of(7.50±1.29) minutes. All CT-guided puncture injections of medical glue were used for localization. The operation time was 18-25 minutes, with an average of(21.25±2.99) minutes. Pneumothorax(25%) appeared in one pig after positioning. The amount of pneumothorax was small, untreated, no hemothorax, pulmonary embolism, and other complications. All Bama miniature pigs underwent thoracoscopy removal of foreign bodies in the lungs. The operation time was 46-93 minutes, with an average of(66.00±20.12) minutes. The location of the foreign body during the operation was 7-11 minutes, with an average of(8.75±1.71)minutes. The anatomy confirmed that after dissection of isolated pig lungs, the medical micelles were located beside the foreign bodies in the lungs. The diameter of the micelles was 8-12 mm, with an average of(9.50±1.91) mm.The distance between the micelles and the foreign objects in the lung was 9-13 mm, with an average of(11.00±1.83)mm. The positioning success rate was 100%. Conclusion The CT-assisted model for locating foreign bodies in Bama miniature pigs lungs with metal guidewire built into the lungs is established, and it is confirmed that the model is safe and feasible for CT-guided puncture and injection of medical glue to accurately locate foreign bodies and to perform thoracoscopic removal of foreign bodies in the lungs, which lays the foundation for further clinical application.