肺小结节术前CT引导下微弹簧圈与硬化剂定位的对比分析

Preoperative Pulmonary Nodule Localization Methods:A Comparison of Microcoil and Sclerosing Agent

背景与目的肺内小结节往往难以进行胸腔镜术中定位,需要术前计算机断层扫描(computed tomography,CT)引导经皮穿刺定位辅助,本研究旨在比较两种不同定位材料即微弹簧圈和硬化剂(聚桂醇)定位的效果及相关并发症,评价优劣。方法回顾性分析术前CT引导经皮穿刺定位患者371例,根据采用的不同定位材料分为:微弹簧圈组(microcoil group)167例,定位结节196枚、硬化剂组(sclerosing agent group)204例,定位结节239枚。统计分析两组定位效果、并发症、病理资料及手术方案等相关资料。结果微弹簧圈组定位失败率(2.4%)高于硬化剂组(0.5%)(P=0.011),硬化剂定位耗时明显短于微弹簧圈组[(18.78±6.91)min vs(11.99±3.77)min,P=0.000],但微弹簧圈组较硬化剂组选择定位结节与胸膜间距离更深[(9.59±8.62)mm vs(8.13±6.49)mm,P=0.002]。总体并发症上微弹簧圈组显著高于硬化剂组(P=0.000),其中以气胸为主,通过相关危险因素分析提示不同定位方法是独立危险因子。手术方式以楔形切除为主,病理结果以非浸润性病变为主。结论微弹簧圈与硬化剂均是良好的术前定位材料,聚桂醇硬化剂较之微弹簧圈定位失败率更低、并发症更少,定位时长更短,操作简便且费用低廉,值得推广。

Background and objective Small pulmonary nodules are usually difficult to identify during thoraco-scopic resection,and preoperative computed tomography(CT)-guided percutaneous puncture assisted localization can be helpful.The purpose of this study is to compare the localization effect and complication rates of two different methods by microcoil placement and sclerosing agent injection(Lauromacrogol).Methods A retrospective analysis of the clinical data of 371 patients with preoperative pulmonary nodules percutane us puncture localization was performed.According to the use of different materials,they were divided into the microcoil group(167 cases with 196 localized nodules)and the sclerosing agent group(204 cases with 239 localized nodules).The localization effect,complication,pathological results and operation relates data were statistically analyzed.Results The localization failure rate(2.4%)was higher in the microcoil group than in the sclerosing agent group(0.5%)(P=0.011),and the localization time of sclerosing agent group was significantly shorter than the microcoil group[(18.78±6.91)min vs(11.99±3.77)min,P=0.000],but the distance between the selected localized nod-ules and the pleura was deeper in the microcoil group than in the sclerosing agent group[(9.59±8.62)mm vs(8.13±6.49)mm,P=0.002].The overall complications in the microcoil group were significantly higher than those in the sclerosing agent group(P=0.000),in which pneumothorax was the most common.Through the analysis of related risk factors,we revealed that differ-ent positioning methods was independent risk factors.Wedge resection was the main type of surgical method and non-invasive carcinomas were the majority of postoperative pathological results.Conclusion Our study suggests that both microcoil placement and sclerosing agent injection are suitable for preoperative pulmonary nodule localization equivalently,however,com-pared with microcoils placement,injection of lauromacrogol,the sclerosing agent,had lower failure rate,less complications,shorter localization time and it is worthy of promotion also by easy operation and low cost.