CT引导下穿刺定位辅助肺结节胸腔镜手术治疗的临床应用

A Clinical Application Study of CT-guided Puncture Localization's Assist Effect for Pulmonary Nodules in Video-assisted Therapeutic Surgery

目的:探讨术前CT引导下的穿刺定位方法,对辅助电视胸腔镜手术(VATS)切除高危肺结节的价值。方法:回顾性分析2020年1月-2022年7月在石河子大学第一附属医院心胸外科VATS切除高危肺结节的患者共125例(共计143枚肺结节),在CT引导下行VATS术前定位的临床资料。其中亚甲蓝定位组59例(60枚),弹簧圈定位组42例(51枚)、弹簧圈植入联合亚甲蓝染色即联合组24例(32枚)。对比三组定位及楔形切除的技术成功率、手术切除范围、并发症发生率等。结果:三组之间定位和楔形切除的技术成功率均无显著差异(P=0.634和P=0.719);亚甲蓝组并发症发生率、手术切除范围分别与弹簧圈组和联合组之间差异有显著意义(P=0.036和P=0.013,P=0.003和P=0.003),其余两组之间的差异无显著意义(P=0.592和P=0.286)。结论:术前CT引导下行亚甲蓝、弹簧圈及亚甲蓝联合弹簧圈三种定位法,辅助电视胸腔镜手术切除高危肺结节具有相同的可行性及有效性。弹簧圈比亚甲蓝定位手术切除范围更小,对于胸腔镜手术时间安排也有更宽泛的兼容。弹簧圈联合亚甲蓝染料定位不能显著提升弹簧圈定位准确性,反而对病理结果有一定影响,不建议两者联合使用。

Objective:To discuss the relative localization methods of preoperative computed tomography(CT)-guided and their clinical value to assist clinical doctor remove the high-risk pulmonary nodules during the video-assisted therapeutic surgery(VATS).Methods:Clinical data of 143 lung nodules(LNs)in 125 patients located underwent CT-guide before video-assisted therapeutic surgery(VATS)were analyzed retrospectively from January 2020 and July 2022 at the cardiothoracic surgery department of First Affiliated Hospital of Shihezi University,including 59 cases(60 LNs)in methylene blue(MB)group,42 cases(51 LNs)in the coil group and 24 cases(32 LNs)in coil combined MB group.We compared the technical success of localization and wedge resection between three groups.Results:There were no significant differences in technical success rates of localization and wedge resection between the three groups(P=0.634 and 0.719).MB group show a significant difference to the coil group and coil combined MB group(P=0.036 and 0.013,P=0.003 and 0.003)in complication incidence and the range of wedge resection,respectively.But there is no significant difference between coil group and coil combined MB group(P=0.592 and P=0.286).Conclusion:The three methods of preoperative CT-guided with methylene-blue,coil or coil combined methylene-blue localization for lung nodules show a similar effectiveness feasibility.Relative to MB localization,coil and coil combined MB localization show a smaller range of wedge resection.Relative to the diffusion property of MB localization, the stable coil localization might be compatible with a longer delay for the schedule of VATS.The combination of coil and MB localization cannot significantly improve the accuracy of coil localization,but rather has a certain impact on pathological results.It is not recommended to use both in combination.