肺小结节胸腔镜切除术前定位方法的应用进展

Advances in the application of preoperative localization methods in thoracoscopic resection of small pulmonary nodules

随着低剂量CT(low-dose computed tomography,LDCT)在肺癌筛查运用中的日益普遍,越来越多的肺结节被检出,鉴别其良恶性显得尤为重要,电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)由于具有创伤小、恢复快等优势,在临床中应用较为广泛,成为肺小结节诊断及治疗的重要手段。VATS术前对肺小结节进行精确定位是手术成功的关键环节,近年来一系列术前辅助定位技术应运而生,包括CT引导、术中超声引导、近红外成像技术及支气管镜下引导。通过在影像系统引导下注入液体材料或金属材料标记,包括亚甲蓝、医用胶、对比剂、带钩金属丝、弹簧圈及肺结节定位针,以方便外科医生能够在术中精准定位病灶并予以切除。然而最佳的定位技术尚无统一标准,本文综述了近年来肺小结节VATS术前定位的各种技术手段,并对各种方法的优点及不足进行分析及总结。

Objective With the increasing prevalence of low-dose computed tomography(LDCT)in the lung cancer screening,more and more pulmonary nodules have been detected,and it becomes particularly important to identify the benign and malignant of the nodules.Video-assisted thoracoscopic surgery(VATS)has been widely employed in clinical practice due to its advantages of less trauma and rapid recovery,and it has become an important means for diagnosing and treating small pulmonary nodules.Preoperative precise localization of pulmonary nodules is the key point to ensure a successful VATS surgery.In recent years,a lot of preoperative auxiliary localization techniques have emerged,including CT guidance,intraoperative ultrasound guidance,near-infrared imaging technology,and bronchoscopic guidance.The injection of liquid materials or placement of metal material markers,including methylene blue,medical glue,contrast agent,hook wire,spring coil and pulmonary nodule localization needle,can facilitate the surgeon to accurately locate the lesion and remove the lesion during VATS operation.However,there is no unified standard for the optimal positioning technology so far.This paper summarizes all kinds of technical means used for localization of small pulmonary nodules before VATS operation in recent years,and the advantages and disadvantages of these methods are discussed.(J Intervent Radiol,2022,31:1216-1221)