CT引导下硬化剂联合术中体表定位在肺楔形切除治疗外周性早期肺腺癌中的应用效果

Effect of preoperative CT-guided sclerotherapy combined with intraoperative body surface localization in lung wedge resection in the treatment of peripheral early lung adenocarcinoma

目的探讨术前CT引导下硬化剂联合术中体表定位在肺楔形切除治疗外周性早期肺腺癌患者中的临床应用效果。方法选取2019年3月至2021年12月河北邯郸市第一医院胸外科收治的202例外周性早期肺腺癌患者,采用随机数字表法将其分为硬化剂组和对照组,每组101例。硬化剂组采用术前CT引导下硬化剂联合术中体表定位指导肺楔形切除治疗,而对照组采用术中体表定位指导肺楔形切除治疗。比较两组患者的定位效果、手术相关指标、肺功能指标及并发症发生情况。结果硬化剂组患者的平均定位时长、结节距离胸膜穿刺点平均距离小于对照组,术前定位成功率(99.01%)高于对照组(93.07%),差异均有显著性(P<0.05)。硬化剂组的手术时间、术中出血量、引流管留置时间、日平均引流量低于对照组,差异有显著性(P<0.05),而两组的住院时间、住院费用比较差异无显著性(P>0.05)。术前两组患者的第1秒用力呼气容积(forced expiratory volume in one second,FEV1)占预计值百分比(FEV1%pred)、用力肺活量(forced vital capacity,FVC)占预计值百分比(FVC%pred)比较差异均无显著性(P>0.05);术后2周,两组FEV1%pred、FVC%pred均明显低于术前,但硬化剂组明显高于对照组,差异有显著性(P<0.05)。硬化剂组术后并发症发生率(3.96%)明显低于对照组(11.88%),差异有显著性(P<0.05)。结论应用术前CT引导下硬化剂联合术中体表定位进行肺楔形切除治疗外周性早期肺腺癌时,较单一应用术中体表定位进行肺楔形切除的定位更加准确,手术更加精准,值得临床应用。

Objective To investigate the effect of preoperative CT guided sclerosing agent combined with intraoperative surface localization in lung wedge resection for patients with peripheral early lung adenocarcinoma.Method From March 2019 to December 2021,202 patients with peripheral early lung adenocarcinoma admitted to the Department of Thoracic Surgery of the First Hospital of Handan City,were randomly divided into sclerosing agent group and control group,with 101 cases in each group.In the sclerosing agent group,the sclerosing agent guided by preoperative CT combined with intraoperative body surface localization was used for pulmonary wedge resection,while in the control group,the sclerosing agent guided by intraoperative body surface localization combined with pulmonary wedge resection was used.The localization effect,operation related indexes,pulmonary function indexes and complications of the two groups were compared.Result The average localization time and the average distance between the nodule and the pleural puncture point in the sclerosing agent group were shorter than those in the control group,and the success rate of preoperative localization(99.01%)was higher than that in the control group(93.07%),with significant differences(P<0.05).The operation time,intraoperative blood loss,drainage tube retention time,and daily average drainage volume in the sclerosing agent group were lower than those in the control group,with significant differences(P<0.05),but there was no significant difference between the two groups in terms of hospital stay and hospital costs(P>0.05).There was no significant difference between the two groups in the percentage of forced expiratory volume in one second(FEV1%pred)and forced vital capacity(FVC%pred)before operation(P>0.05);FEV1%pred and FVC%pred in the two groups were significantly lower than those before 2 weeks after operation,but those in the sclerosing agent group were significantly higher than those in the control group(P<0.05).The incidence of postoperative complications in the sclerosing agent group(3.96%)was significantly lower than that in the control group(11.88%)(P<0.05).Conclusion The application of preoperative CT guided sclerosing agent combined with intraoperative body surface localization in lung wedge resection for the treatment of peripheral early lung adenocarcinoma is more accurate,and the operation is more accurate,which is worthy of clinical application.