电视胸腔镜手术中难以探及肺内小结节术前CT引导下Hook-wire定位的临床应用探讨

doi:10.12117/jccmi.2019.06.005

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摘要目的：探讨电视胸腔镜手术中难以探及的肺内小结节（≤10 mm）术前CT引导下Hook-wire定位的临床应用价值，并初步探讨积极微创手术对微小结节的必要性和可行性。方法：2017年12月—2018年6月共45例患者行术前CT引导下Hook-wire（Accura TM BLN 21ga×10 cm）定位，并在电视胸腔镜下手术。结果：45例患者共45个微小结节，男22例，女23例。病灶位于左肺上叶前段3个，尖后段3个，外侧基底段3个，后基底段5个；右肺上叶前段8个，尖段2个，后段6个，中叶外侧段3个，下叶背段4个，外侧基底段2个，前基底段2个，后基底段4个。实性结节13个，纯磨玻璃结节22个，混合磨玻璃结节10个。5～10 mm 17个，5 mm以下28个。CT引导下Hook-wire定位成功率为95.56%，电视胸腔镜下切除率100%。术后组织学结果：原位腺癌25例，炎性病变8例，良性肿瘤及肿瘤样病变12例。结论：CT引导下Hook-wire肺微小结节术前定位准确率高，并发症轻微，有助于临床在术中及时发现、切除病灶，减少手术时间，有利于患者的早日康复，值得临床推广。

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	高德培
	董兴祥
	李振辉
	封俊
	田川
	张大福

关键词 ：肺肿瘤, 肺疾病, 胸腔镜检查, 体层摄影术, 螺旋计算机

Abstract：Objective: To explore the clinical value of Hook-wire localization under CT guidance before operation of small pulmonary nodules(≤10 mm), which are difficult to be detected in video-assisted thoracoscopic surgery, and to discuss the necessity and feasibility of active minimally invasive surgery for small nodules. Methods: From December 2017 to June 2018, a total of 45 patients underwent preoperative CT guided Hook-wire(Accura TM BLN 21 ga×10 cm) localization and underwent video assisted thoracoscopic surgery. Results: Forty-five patients(22 males and 23 females) had a total of 45 micro nodules. There were 3 nodules in anterior segment and 3 in apicoposterior segment of left upper lobe, 3 in lateral basal segment and 5 in posterior basal segment of left inferior lobe, 8 in anterior segment, 2 in apical segment and 6 in posterior segment of right upper lobe, 3 in right middle lobe, 4 in dorsal segment, 2 in lateral basal segment, 2 in anterior basal segment, 4 in posterior basal segment of right inferior lobe. There were 13 solid nodules, 22 pure ground-glass nodules and 10 mixed ground-glass nodules. There were 17 nodules with diameter between 5 mm to 10 mm, 28 nodules less than 5 mm. The success rate of Hook-wire guided by CT was 95.56%, and the rate of video assisted thoracoscopic resection was 100%. Histological findings were 25 cases of adenocarcinoma in situ, 8 cases of inflammatory lesions, 12 cases of benign tumors and tumor like lesions. Conclusion: CT guided Hook-wire pulmonary micro nodules location have high accuracy and slight complications before operation. It is helpful to detect and remove the lesion in time, shorten the time of operation, and is beneficial to the early recovery of the patients, and it is worthy of clinical promotion.

Key words： Lung neoplasms Lung diseases Thoracoscopy Tomography, spiral computed

收稿日期: 2018-07-18

PACS:	Ｒ734.2
	Ｒ730.49
	Ｒ814.42

通讯作者: 张大福，云南省肿瘤医院昆明医科大学第三附属医院，650118。E-mail：tosney@126.com

作者简介: 高德培（1969-），男，云南大理人，主任医师。E-mail：gaodepei311@sohu.com

引用本文:

高德培，董兴祥，李振辉，封俊，田川，张大福. 电视胸腔镜手术中难以探及肺内小结节术前CT引导下Hook-wire定位的临床应用探讨[J]. 中国临床医学影像杂志, 2019, 30(6): 398-400.
GAO De-pei, DONG Xing-xiang, LI Zhen-hui, FENG Jun, TIAN Chuan, ZHANG Da-fu. Clinical application of preoperative CT guided Hook-wire localization in pulmonary nodules difficult detected during video-assisted thoracoscopic surgery. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(6): 398-400.

链接本文:

http://www.jccmi.com.cn/CN/10.12117/jccmi.2019.06.005 或 http://www.jccmi.com.cn/CN/Y2019/V30/I6/398

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