CT引导下术前经皮肺穿刺注射吲哚菁绿定位肺内小结节和磨玻璃结节有效性和安全性分析

Effectiveness and Safety of CT-guided Percutaneous Intrapulmonary Injection of Indocyanine Green for Localization of Pulmonary Nodules and Ground Glass Opacity

目的研究CT引导下肺内注射吲哚菁绿(ICG)用于肺内小结节及磨玻璃影术前定位的有效性和安全性。方法收集2018年10月到2019年7月连续人住北京胸科医院34例CT上表现为肺内小结节或磨玻璃结节疑诊为肺癌、行胸腔镜手术治疗的患者(39个结节),结节大小0.3~2.0(0.9±0.3)cm,其中实性结节6个,不纯磨玻璃结节9个,纯磨玻璃结节24个。术前在CT引导下向肺内注射ICG进行定位,记录患者的结节定位、手术及病理等信息。主要评价指标为定位成功率和并发症发生率。结果20.6%(7/34)的患者出现轻微并发症,其中6例为少量气胸,1例为肺内出血,均无需特殊处理。无ICG相关不良反应。术中所有患者均可见荧光显影,2例患者ICG在胸腔内弥散,但在荧光最亮处仍然可以找到病灶。一处结节因直径过小(0.3 cm)未能在切除肺叶中找到,定位成功率为97.4%(38/39)。荧光持续时间可超过5h。结论CT引导下肺内注射ICG定位肺内小结节和磨玻璃结节是安全有效的。

Objective To investigate the efectiveness and safety of CT-guided intrapulmonary ijction of indocyanine green(ICG)for preoperative localization of small pulmonary nodules and ground glass opacities.Methods From October 2018 to July 2019,a total of 34 consecutive patients(39 nodules)who were suspected to be lung cancer and underwent thoracoscopic surgery were enolled.The size of the nodules was 0.3-2.0(0.9±0.3)cm,including 6 solid nodules,9 impure ground glass nodules and 24 pure ground glass nodules.Before operation,ICG was injected into the lung under the guidance of CT for localization.The patient's nodules location,operation and pathology were recorded.The main outcome measures were localization success rate and complication rate.Results Seven patients(20.6%)had mild complications including six pneumothorax and one intrapulmonary hemorthage,but all these patients need no special treatment.There was no ICG related side efection all patients.ICG fuorescence can be observed in all localized nodules during surgery.In two patients,the fuorescence was diffused in the thoracic cavity,but the lesion can still be found at the brightest spot of fuorescence.Thirty-eight(97.4%)lesions were successfully found under fuorescence guidance,only one nodule was not found because of its small size(0.3 cm).The shortest fluorescence retention time was more than 5 hours.Conclusion CT guided intrapulmonary injection of ICG for localization of pulmonary nodules and ground glass opacities is safe and efective.