摘要
背景与目的肺内多发小结节微创手术的成功与否有赖于术前定位,然而目前缺乏针对肺内多发小结节术前定位的临床研究。本研究旨在与同期肺内单发小结节定位相比,探讨行电视胸腔镜手术(video-assisted thoracoscopic surgery, VATS)术前电子计算机断层扫描(computed tomography, CT)引导下留置微弹簧圈定位肺内多发小结节的临床价值。方法回顾性分析术前行肺内小结节微弹簧圈定位者235例的临床资料。根据结节是否为单发分为:单发结节组184例(single nodule group),多发结节组51例(multiple nodules group)。单发结节组常规方式CT引导下定位,多发结节组在CT引导下分级、分批次留置微弹簧圈定位,统计分析两组定位成功率、并发症、病理结果及定位操作相关数据等。结果多发结节组定位成功率达90.2%,与同期单发结节组成功率相比无统计学差异(90.2%vs 94.6%,P=0.205),多发结节组气胸发生率与单发结节组亦无统计学差异(21.6%vs 14.1%, P=0.179),然而多发结节组的操作时间明显长于单发结节组的操作时间[(30.6±6.6) min vs (19.9±7.4) min, P=0.000]。两组均无大咯血、空气栓塞及血胸发生等严重并发症。两组均无因术中无法定位结节而中转开胸者;手术方式以亚肺叶切除为主;术后病理以非浸润性病变为主。结论对于需行胸腔镜手术的肺部多发小结节,按照一定策略,术前CT引导下分级、分批次留置微弹簧圈的定位方法安全、有效,值得推广。
Background and objective Localization of multiple small lung nodules is the technical difficulty of minimally invasive operation resection.However,there are few clinical studies on the preoperative localization of multiple small lung nodules.This study was designed to evaluate the clinical value of preoperative computed tomography (CT)guided microcoil localization for multiple small lung nodules compared with single small lung nodule before video-assisted thoraco- scopic surgery (VATS).Methods A retrospective analysis of the clinical data of 235patients with preoperative pulmonary nod- ules microcoil localization was performed.According to whether the nodules were single,they were divided into single nodule group (184cases)and multiple nodules group (51 cases)(multiple nodules group).The single nodule group was positioned under CT-guided conventional methods.The multiple nodules group were CT guided localized by microcoil in batches accord- ing to priority before VATS.The success rate,complications,pathological results and localization operations related data were statistically analyzed.Results The success rate of localization in multiple nodule groups was 90.2%,there was no significant dif- ference compared with the single nodule group (90.2%vs 94.6%,P=0.205).The occurrence rate ofpneumothorax in multiple nodule group and single nodule group was no statistical difference (21.6%vs 14.1%,P=0.179),however,the operation time in the multiple nodule group was significantly longer than the single nodule group [(30.6±6.6)min vs (19.9±7.4)min,P=0.000]. There were no serious complications such as massive hemoptysis,air embolism or hemothorax.There was no conversion to thoracotomy due to failure of localizing the nodules during operation.Sub-lobectomy was the main method of operation.The majority of postoperative pathologies were non-invasive carcinomas.Conclusion For multiple small lung pulmonary nodules requiring thoracoscopic surgery,according to certain strategies,preoperative CT-guided localized by microcoil in batches ac-cording to priority before VATS is safe and effective,and worthy of promotion.
作者
李凤卫
陈应泰
边建伟
辛兴
刘思杰
Fengwei LI;Yingtai CHEN;Jianwei BIAN;Xing XIN;Sijie LIU(Department of Thoracic Surgery,Beijing Aerospace General Hospital,Beijing 100076,China)
出处
《中国肺癌杂志》
CAS
CSCD
北大核心
2018年第11期857-863,共7页
Chinese Journal of Lung Cancer
基金
首都临床特色应用研究(No.Z181100001718055)
2015年北京航天总医院创新基金项目(No.2015-045)资助
Innovation Fund Project of China Aerospace Science and Technology Corporation's Technology(No.JH.2017.0579)~~
关键词
计算机断层扫描
定位
肺肿瘤
多发性
肺切除术
Computed tomography (CT)
Localization
Lung neoplasms
Multiple primary
Pneumonectomy
