肺外周结节HOOKWIRE 穿刺定位后脱落原因分析及应用体会

Analysis of cause and application of detachment after hookwire puncture positioning of peripheral lung nodules

目的 研究肺外周结节经CT引导下术前Hookwire穿刺定位后脱落与穿刺部位及胸壁厚度的关系。方法 2017年7月~2021年12月我院因外周肺结节行胸腔镜手术的病人190例。所有病人术前均在CT引导下行HOOKWIRE穿刺定位,记录穿刺部位、定位针是否脱落、胸壁厚度以及穿刺结束时间至手术开始切皮的间隔时间,Logistics回归分析以及受试者工作特性(ROC)曲线分析,探讨影响定位针脱落的危险因素。结果 190例病人合并COPD3例,胸腔重度粘连12例。脱落31例,脱落率16.3%。其中,肩胛下角线内侧31例,脱落15例,脱落率48.4%;腋中线-肩胛下角线67例,脱落10例,脱落率14.9%;锁骨中线-腋中线65病例,脱落5例,脱落率7.6%;锁骨中线内侧27例,脱落1例,脱落率3.7%,肩胛下角线内测脱落率最高,与其他位置比较,差异有统计学意义(P<0.05);定位针脱落病例胸壁组织厚度(49.38±6.28)mm,定位针未脱落病例胸壁厚度(36.36±7.77)mm,两组比较,差异有统计学意义(P<0.05)。穿刺与手术间隔时间73~98分钟,平均(81.99±4.48)分钟。结论 定位针脱落与胸壁厚度有关,肺外周结节术前胸背部尤其是肩胛下角线内脱落比例明显偏高。肺外周结节体表投影在肩胛下角线内侧的病例,应优选考虑其他定位方式。

Objective To study the relationship between detachment and puncture site and chest wall thickness after preoperative positioning of peripheral lung nodules by CT-guided Hookwire puncture.Methods From July 2017 to December 2021,190 patients in our hospital underwent thoracoscopic surgery for peripheral lung nodules.All patients underwent preoperative CT-guided HOOKWIRE puncture mapping,recording the puncture site,whether the needle had fallen off,chest wall thickness,and the interval between the end of the puncture and the start of the surgery,logistic regression analysis,and receiver operating characteristic(ROC) curve analysis to explore the risk factors affecting needle fall off.Results Clinical data were collected for 190 patients,including 119 males and 71 females,age 22 to 78(58.1 ± 10.2) years.There were 31 cases of shedding,with a shedding rate of 16.3%.Among them,31 cases were detached in the medial aspect of the subscapular horn line,15 cases were detached,with detachment rate being 48.4%;67 cases were detached in the medial axillary line,10 cases were detached,with detachment rate being 14.9%;65 cases were detached in the medial axillary line of the midclavicular line,5 cases were detached,with detachment rate being 7.6%;27 cases were detached in the medial axillary line,1 case was detached,with detachment rate being 3.7%;the detachment rate was highest in the subscapular horn line,with statistical significance(P<0.05) compared with other locations;the tissue thickness of the thoracic wall was(49.38 ± 6.28) mm,but the tissue thickness of the thoracic wall was(36.36 ± 7.77) mm,with statistical significance(P<0.05).The interval between puncture and operation was 73 to 98 min,with an average one of(81.99 ± 4.48) min.Conclusions The detachment of the positioning needle is related to the thickness of the chest wall,and the proportion of detachment is significantly higher in the chest back,especially in the subscapular angle,before surgical treatment of peripheral lung nodules.In cases of peripheral pulmonary nodules with surface projections medial to the inferior scapular horn line,other methods of localization should be preferably considered.