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肺小结节术前CT引导下Hook-wire定位的临床应用研究
Clinical Research of CT-guided Preoperatye Pulmonary Nodule Positioning Technique
【作者】 闾夏轶；
【导师】 倪一鸣；
【作者基本信息】 浙江大学 ， 外科学， 2011， 博士
【摘要】 背景：对于直径小于1cm的肺小结节,胸腔镜是获取组织学依据的唯一选择,但由于小结节位置、大小及性状的关系,部分小结节在术中极难定位。数年前即有学者开始尝试使用各种方法进行术前的肺小结节定位。术前结节定位为术中准确切除小结节提供了便利。本文从适应症、结果、并发症等方面回顾性分析了胸腔镜术前CT引导下hook-wire定位的临床应用价值。方法：回顾性分析从2009年1月至2010年12月我科行胸腔镜肺小结节楔形切除术的患者,共计76名患者资料。其中,2009年1月至2009年12月共33名患者均未行hook-wire定位(A组)。2010年1月至2010年12月共43名患者均于术前接受了CT引导下肺小结节hook-wire定位(B组)。小结节直径均小于2cm。患者均在穿刺定位后2小时内手术。评价指标包括定位成功率,定位相关并发症,中转开胸比率等。组间数据比较使用卡方检验,多变量分析使用logistic回归分析方法评价肿块大小和距胸膜的距离这两个因素对中转开胸率的影响。结果：4例患者出现穿刺后气胸,4例患者脱钩。A组中8例患者中转开胸(24%),B组中2例患者中转开胸(5%),P<0.05。中转开胸的最主要原因在A组中是定位困难,在B组中则是胸膜重度粘连和脱钩。中转开胸的主要相关因素是结节的直径。结论：胸腔镜术前CT引导下肺小结节hook-wire定位有一定的临床应用价值,可帮助术中精确定位肺小结节位置,有效降低中转开胸率,缩短手术时长。
【Abstract】 Background:VATS Wedge resection is an effective method to diagnose pulmonary nodules, but it is closely associated with the location, size and histophathology of the nodule. Some pulmonary nodules are difficult to estimate their accurate position. Preoperative positioning of the nodule provides a convenient method for VAST procedures. In this article, we retrospectively analyzed the clinical significance of CT-guided preoperative pulmonary nodule positioning technique.Method:We retrospectively analyzed76patients who underwent VATS wedge resection for pulmonary nodules between Jan2010and Apr2011. Among them,36patients experinced wedge resection without preopertaive Hookwire positioning technique(Group A), and43patients underwent preoperative pulmonary nodule positioning technique before performing VATS wedge resection of the pulmonary nodule. Diameter of the lesion ranges less than2cm. Wedge resection was conducted after completing the positioning in two hours. We have used the success rate in positioning technique, rate of positioning related related complications, and rate of transferring thoracotomy to further evaluate its efficacy.Results:4patients had pneumothorax. and4patients experienced dislodge.8patients (24%) transfered to open thoracotomy in Group A. and only2patients transfered to open thoracotomy in Group B (P<0.05). The reason for transferring to open thoracotomy for Group A is difficulties in positioning the nodlues, and for Group B. severe adhesion of the tharacic cavity and dislodge contributed the most. Main contributing factor for transferring thoracotomy is the diameter of nodule.Conclusion:CT-guided preoperative pulmonary nodule positioning technique has a valuable clinical significance for small solitary pulmonary nodules, it plays an important role in accurate positioning of small pulmonary nodules, and decrease the rate of transferring thoracotomy, shorten operating time.