摘要
目的评估肺结节定位针在VATS术前肺结节定位的有效性及安全性。方法收集自2019年11月~2021年1月在我院行VATS术前定位的192例患者(共214枚肺结节),通过样本估算,采用较大样本量并尝试多枚肺结节的同时定位来进一步评价肺结节定位针临床运用的有效性、安全性及可行性,并分析与定位操作相关并发症的危险因素。结果肺结节定位针定位成功率97.20%(208/214),4枚移位及2枚脱钩,无死亡或严重并发症发生。肺结节大小(7.32±2.67)mm、结节与胸膜距离(10.19±9.03)mm、定位针胸膜下深度(21.44±9.99)mm、锚爪与结节距离(5.63±5.24)mm、平均定位时间(17.43±11.29)min。定位后45例(23.44%)出现并发症,其中无症状气胸26例,肺出血25例,疼痛2例,咯血1例。多因素回归分析显示:定位时间(OR=1.082,95%CI:1.033~1.134,P<0.05)及定位体位(OR=3.276,95%CI:1.314~8.169,P<0.05)是气胸发生的独立危险因素;定位针胸膜下深度(OR=1.067,95%CI:1.026~1.110,P<0.05)及定位时间(OR=1.057,95%CI:1.008~1.110,P<0.05)是肺出血发生的独立危险因素,且气胸与肺出血之间呈正相关(r=0.209,P=0.004)。所有肺结节均经VATS下切除,平均手术时间(85.90±46.47)min、术后住院时间(4±2)d,切除肺组织体积(95.37±95.19)cm3。结论CT引导下肺结节定位针定位技术成功率高,并发症发生率低且级别轻微,是一项有效、安全可行的术前定位技术。
Objective To evaluate the efficacy and safety of needle localization of pulmonary nodules before video-assisted thoracoscopic excision surgery(VATS).Methods From November 2019 to January 2021,192 patients underwent preoperative CT-guided needle localization of 214 pulmonary nodules in our hospital.Through the sample estimation method,a larger sample size and simultaneous localization of multiple pulmonary nodules were tried to further evaluate the efficacy and safety of needle localization of pulmonary nodules,and to analyze the risk factors of localization-related complications.Results The technical success rate was 97.20%(208/214)with 4 needle displacement and 2 needle dislocations.There was no death or serious complication during needle localization.The mean size of nodules was(7.32±2.67)mm,and mean distance from the pleura was(10.19±9.03)mm.The average subpleural depth of the needle was(21.44±9.99)mm with(5.63±5.24)mm between needle anchor and nodule.The mean positioning time was(17.43±11.29)min.Complications after needle localization(45/192)included asymptomatic pneumothorax(26/192),pulmonary hemorrhage(25/192),chest pain(2/192),and hemoptysis(1/192).Logistic regression analysis showed that positioning time(OR=1.082,95%CI:1.033-1.134,P<0.05)and patient position(OR=3.276,95%CI:1.314-8.169,P<0.05)were significant risk factors for pneumothorax whereas the subpleural depth of the needle(OR=1.067,95%CI:1.026-1.110,P<0.05)and positioning time(OR=1.057,95%CI:1.008-1.110,P<0.05)were significant risk factors for pulmonary hemorrhage.There was a positive correlation between pneumothorax and pulmonary hemorrhage(r=0.209,P=0.004).All pulmonary nodules were successfully resected under VATS with average operative time of(85.90±46.47)minutes,average postoperative hospitalization duration of(4±2)days,and average volume of resected lung tissue of(95.37±95.19)cm3.Conclusion With a larger sample size in this study,CT-guided needle localization of pulmonary nodules prior to VATS is feasible and safe with high success rate and low incidence of mild complications.
作者
张华
郭坚溪
肖伟俅
张彦舫
孔健
ZHANG Hua;GUO Jian-xi;XIAO Wei-qiu;ZHANG Yan-fang;KONG Jian(Department of Interventional Radiology,Second Clinical Medical College of Jinan University/Shenzhen People’s Hospital,Guangdong 518020,China)
出处
《影像诊断与介入放射学》
2021年第5期364-370,共7页
Diagnostic Imaging & Interventional Radiology
基金
广东省重点领域研发计划资助(2020B010165004)。
关键词
肺结节
肺结节定位针
体层摄影技术
电视胸腔镜
定位
Pulmonary nodule
Pulmonary nodules localization needle
Computed tomography
Video-assisted thoracoscopic surgery
Localization
