肺小结节胸腔镜术前定位方法

Positioning method of small lung nodules before thoracoscopy

随着胸部CT检查的普及,肺小结节的诊断日益增多,尤其是在伴有肺癌高危因素的患者行CT筛查时尤为明显。随着社会经济的不断发展,医疗水平得以提高,电视胸腔镜手术对于肺小结节的诊断和治疗提供了一种微创治疗方式。如何精准术前定位及标记病灶,以助电视胸腔镜下切除病灶的方法层出不穷。临床有关研究显示,肺内小结节直径在5 mm时恶变的几率为1%,随着直径的增长,疾病恶变的几率也会升高,当直径大于20 mm时恶变的几率可高达85%,因此早期诊断对提高临床疗效有着积极的意义。本次研究主要针对临床中常用的几种定位方法,例如CT引导下经皮穿刺医用胶定位、亚甲蓝定位、放射性同位素定位、金属材料介导定位等进行分析,总结其应用中的利与弊,希望能够为后期临床诊断提供指导价值。

With the popularization of chest CT examination,the diagnosis of small lung nodules is increasing,especially when CT screening is performed in patients with high-risk factors for lung cancer.With the continuous development of the social economy and the improvement of medical standards,video-assisted thoracoscopic surgery provides a minimally invasive treatment for the diagnosis and treatment of pulmonary nodules.The methods of accurately locating and marking the lesions before surgery to help the video-assisted thoracoscopic resection of the lesions are endless.Clinical studies have shown that when the diameter of a small nodule in the lung is 5mm,the probability of malignant transformation is 1%.As the diameter increases,the probability of malignant disease will increase.When the diameter is greater than 20mm,the probability of malignant transformation can be as high as 85%.Early diagnosis has positive significance for improving clinical efficacy.This study mainly focuses on several positioning methods commonly used in clinical practice,such as CT-guided percutaneous puncture medical glue positioning,methylene blue positioning,radioisotope positioning,metal material-mediated positioning,etc.,to analyze and summarize the advantages and disadvantages of its application,and to provide guidance value for later clinical diagnosis.