CT引导下经皮肺穿刺定位在亚肺叶切除术中应用

APPLICATION OF CT-GUIDED PERCUTANEOUS PULMONARY NODULE LOCALIZATION IN SUBLOBECTOMY

目的探讨CT引导下经皮穿刺肺结节定位在电视胸腔镜手术(VATS)亚肺叶切除术中的应用价值。方法选取2018年4月—2019年7月入住我科的73例病人,其CT表现为肺内单发磨玻璃结节(直径0.5~2.0 cm),均行胸腔镜手术治疗。术前在CT引导下向肺内结节旁(<1 cm)注射亚甲蓝(亚甲蓝组,23例)、标记hook-wire(hook-wire组,25例)及微弹簧圈(微弹簧圈组,25例)进行定位。比较3组定位成功率、定位并发症发生率、定位时间、手术时间、切除病变组织后寻找病灶时间及住院总费用。结果3组定位成功率差异无显著性(P>0.05)。亚甲蓝组有47.8%的病人出现定位并发症(血、气胸11例,其中1例因气胸量较大予以胸腔闭式引流),hook-wire组、微弹簧圈组并发症发生率分别为20.0%、12.0%,3组并发症发生率差异具有统计学意义(χ^(2)=9.715,P<0.05)。与微弹簧圈组及hook-wire组相比,亚甲蓝组切除病变组织后寻找病灶时间明显延长(F=3.148,P<0.05)。3组定位时间、手术时间、住院总费用差异均无显著性(P>0.05)。结论在肺内磨玻璃结节外科治疗中,CT引导下经皮穿刺微弹簧圈定位并发症发生率低,有助于迅速确定离体组织病变结节位置,是安全有效的术前定位方式。

Objective To investigate the application value of computed tomography(CT)-guided percutaneous pulmonary nodule localization for sublobectomy in video-assisted thoracoscopic surgery.Methods Seventy-three patients admitted from April 2018 to July 2019 were selected and treated with thoracoscopic surgery for single ground-glass nodules(diameter of 0.5-2.0 cm)on CT scan.Methylene blue(methylene blue group,n=23),hook-wire(hook-wire group,n=25),and micro-coil(micro-coil group,n=25)were injected preoperatively next to the pulmonary nodules(<1 cm)under the guidance of CT for localizing.The success rate,complication rate of different localization methods,localization time,operation time,lesion search time after excision of pathological tissues,and total hospitalization expenses were compared among the three groups.Results There was no significant difference in the success rate of localization among the three groups(P>0.05).A total of 47.8%of patients in the me-thylene blue group had complications(hemothorax and pneumothorax in 11 patients,of whom 1 patient received thoracic closed drainage due to large pneumothorax volume),and the complication rates in the hook-wire and micro-coil groups were 20.0%and 12.0%,respectively(χ^(2)=9.715,P<0.05).Compared with the micro-coil and hook-wire groups,the lesion search time after excision of pathological tissues was significantly prolonged in the methylene blue group(F=3.148,P<0.05).No significant difference was found in localization time,operation time,and total hospitalization expenses among the three groups(P>0.05).Conclusion CT-guided percutaneous micro-coil localization has a low complication rate and is helpful to quickly determine the location of di-seased nodules in vitro in the surgical treatment of ground-glass nodules in the lung.Therefore,it is a safe and effective preoperative localization method.