孤立性肺结节两种胸腔镜术前定位方法的对比分析

A comparative study of two preoperative thoracoscopic localization methods for solitary pulmonary nodule

目的 探讨CT引导下微弹簧圈定位与医用胶结合亚甲蓝(MGMB)定位在孤立性肺结节(SPN)电视胸腔镜手术(VATS)前定位中的临床价值,并分析定位后发生并发症的危险因素。方法 选取我院收治的292例SPN患者,分为微弹簧圈组129例,MGMB组163例,比较两种定位技术的安全性和成功率,以及潜在临床价值。结果 所有患者均于VATS术前36 h内完成定位,相比于微弹簧圈组,MGMB组的定位时间更短(7.42±2.58 vs 14.80±3.60)min,差异有统计学意义(P<0.001),住院时间更短(5.67±2.16 vs 10.26±3.69)天,差异有统计学意义(P<0.001)。两组术前定位成功率分别为96.9%(125/129)和100%(163/163)。定位过程中无死亡或严重并发症发生,两组并发症发生率差异无统计学意义(P=0.902)。Logistic回归分析显示,定位时间是总并发症发生的危险因素(OR=1.119,95%可信区间,1.002~1.249,P=0.045)。结论 两种技术都可以在VATS之前安全有效地定位SPN,但MGMB组的定位时间及住院时间更短,实用性及潜在的临床价值更高,值得临床推广。

Objective To compare the clinical value of CT-guided micros coil localization and medical glue combined with methylene blue(MGMB)localization in the preoperative localization of isolated pulmonary nodules(SPN)VATS,and to ana⁃lyze the risk factors for complications after localization.Methods We collected 292 patients with isolated pulmonary nodules admitted to our thoracic surgery department,with 129 in the microscoil group and 163 in the MGMB group,and compared the safety and success rate of the two localization techniques,as well as their potential clinical value.Results All patients were lo⁃calized within 36 h before VATS,and the MGMB group had shorter localization time(7.42±2.58 vs 14.80±3.60 min,P<0.001),shorter hospital stay(5.67±2.16 vs 10.26±3.69 d,P<0.001),and shorter operative time(94.64±46.41 vs 129.64±64.70 min,P<0.001)compared with the microscoil group.The preoperative localization success rates were 96.9%(125/129)and 100%(163/163)in the two groups,respectively.No death or serious complications occurred during localization,and the complication rates were not statistically different between the two groups(P=0.902).Logistic regression analysis showed that time to localization was a risk factor for total complications(OR=1.119,95%confidence interval,1.002~1.249,P=0.045).Con⁃clusion Both techniques can safely and effectively localize the SPN before VATS,but the localization time and hospital stay are shorter in the MGMB group,and the practicality and potential clinical value are higher,which is worthy of clinical promotion.