单孔胸腔镜术前CT引导下Hook wire穿刺定位单侧多个或单一肺结节的比较

Comparison of CT-guided Hook wire localization for single or multiple pulmonary nodules before uniportal video-assisted thoracic surgery

目的探讨单孔胸腔镜手术术前CT引导下Hook wire同期穿刺定位单侧肺部多个结节的可行性,并与定位单个结节的准确性、安全性进行比较。方法回顾2016年7月至2019年6月我院单孔胸腔镜手术前行CT引导下Hook wire穿刺定位单侧肺部结节的患者,按定位结节的个数分为单一定位组(A组)与多个定位组(B组,定位结节数≥2),对比两组患者定位的成功率、准确度、并发症发生率等。结果两组共224例,其中A组162例,B组62例。A组定位成功率88.27%,B组87.84%,两组差异无统计学意义(P>0.05),定位后所有单孔胸腔镜手术均顺利完成。B组针道出血与气胸的发生率均明显高于A组(P<0.05)。平均单个结节定位时间A组为(8.98±4.40)min,B组为(7.25±3.50)min,两组间差异有统计学意义(P=0.006)。病灶定位的准确性(病灶与定位针的距离)两组间差异无统计学意义(P=0.407)。结论单孔胸腔镜术前CT引导下Hook wire穿刺定位单侧多个肺部结节的方法与定位单一肺结节相比,同样具有可行性与有效性,但更易发生穿刺针道出血与气胸,需引起注意。

Objective To evaluate the feasibility of CT-guided Hook wire localization for multiple lung nodules before uniportal video-assisted thoracic surgery,and to compare with the accuracy and safety of localization for single nodule.Methods A retrospective analysis of the clinical data of patients who underwent unilateral CT-guided Hook wire localization before uniportal video-assisted thoracic surgery from July 2016 to June 2019 were performed,the patients were divided into multiple localization group(localized nodules≥2,group B)and single localization group(group A)according to the number of localized nodules.Compare the localization success rate,accuracy,and complication rate of the two groups.Results There were 224 patients in the two groups,including 162 in group A and 62 in group B.The localization success rate of group A and group B were 88.27%and 87.84%,the difference between the two groups was not statistically significant(P>0.05).All uniportal video-assisted thoracic surgeries were successfully completed after localization.The incidence of lung hemorrhage and pneumothorax was significantly higher in group B(P<0.05).The average single nodule localization time was(8.98±4.40)minutes in group A and(7.25±3.50)minutes in group B,the difference between the two groups is statistically significant(P=0.006).The accuracy of lesion localization(distance between lesion and the needle)was not significantly different between the two groups(P=0.407).Conclusion Compared with localization of single lung nodule,unilateral CT-guided Hook wire localization for multiple pulmonary nodules before uniportal video-assisted thoracic surgery is also feasible and effective,but the higher rate of lung hemorrhage and pneumothorax should be paid attention to.