中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2012年
7期
401-404
,共4页
俞同福%徐海%刘希胜%宗敏%陈亮%朱全%邵永峰%詹必成
俞同福%徐海%劉希勝%宗敏%陳亮%硃全%邵永峰%詹必成
유동복%서해%류희성%종민%진량%주전%소영봉%첨필성
肺小结节%胸腔镜检查%CT引导%定位
肺小結節%胸腔鏡檢查%CT引導%定位
폐소결절%흉강경검사%CT인도%정위
Small pulmonary nodules%Thoracoscopy%CT-guidance%Localization
目的 探讨CT引导下亚甲蓝与Hookwire联合定位在胸腔镜下孤立性肺小结节(SPN)切除术中的临床应用价值.方法 对56例患者的60枚SPN术前行CT引导下亚甲蓝与Hookwire联合定位后行胸腔镜(VATS)肺楔形切除术.全组患者男19例,女37例；年龄35～81岁,平均(61.1±8.9)岁.结果 56例60枚SPN直径为(6.80±4.12) mm,距壁层胸膜(15.38±4.63) mm.CT引导下定位成功率100％,定位时间(10.76±8.17) min.定位后5例(8.9％)发生局部少量气胸,4例(7.1％)发生肺出血,均无需治疗.60枚肺小结节病灶均准确定位,VATS楔形切除术成功率100％.术后病理显示,肺泡细胞癌(BAC)33枚(55.0％),肺泡细胞癌伴腺癌(BAC+ AC) 11枚(18.3％),肺泡细胞不典型增生(AAH)7枚(ll.8％),炎性肉芽肿4枚(6.7％),错构瘤3枚(5.0％),结核性肉芽肿2枚(3.3％).结论 胸腔镜术前CT引导下亚甲蓝与Hookwire联合定位准确率高,对胸腔镜手术(VATS)楔形切除病灶有极大的帮助作用,具有良好的临床应用价值.
目的 探討CT引導下亞甲藍與Hookwire聯閤定位在胸腔鏡下孤立性肺小結節(SPN)切除術中的臨床應用價值.方法 對56例患者的60枚SPN術前行CT引導下亞甲藍與Hookwire聯閤定位後行胸腔鏡(VATS)肺楔形切除術.全組患者男19例,女37例；年齡35～81歲,平均(61.1±8.9)歲.結果 56例60枚SPN直徑為(6.80±4.12) mm,距壁層胸膜(15.38±4.63) mm.CT引導下定位成功率100％,定位時間(10.76±8.17) min.定位後5例(8.9％)髮生跼部少量氣胸,4例(7.1％)髮生肺齣血,均無需治療.60枚肺小結節病竈均準確定位,VATS楔形切除術成功率100％.術後病理顯示,肺泡細胞癌(BAC)33枚(55.0％),肺泡細胞癌伴腺癌(BAC+ AC) 11枚(18.3％),肺泡細胞不典型增生(AAH)7枚(ll.8％),炎性肉芽腫4枚(6.7％),錯構瘤3枚(5.0％),結覈性肉芽腫2枚(3.3％).結論 胸腔鏡術前CT引導下亞甲藍與Hookwire聯閤定位準確率高,對胸腔鏡手術(VATS)楔形切除病竈有極大的幫助作用,具有良好的臨床應用價值.
목적 탐토CT인도하아갑람여Hookwire연합정위재흉강경하고립성폐소결절(SPN)절제술중적림상응용개치.방법 대56례환자적60매SPN술전행CT인도하아갑람여Hookwire연합정위후행흉강경(VATS)폐설형절제술.전조환자남19례,녀37례；년령35～81세,평균(61.1±8.9)세.결과 56례60매SPN직경위(6.80±4.12) mm,거벽층흉막(15.38±4.63) mm.CT인도하정위성공솔100％,정위시간(10.76±8.17) min.정위후5례(8.9％)발생국부소량기흉,4례(7.1％)발생폐출혈,균무수치료.60매폐소결절병조균준학정위,VATS설형절제술성공솔100％.술후병리현시,폐포세포암(BAC)33매(55.0％),폐포세포암반선암(BAC+ AC) 11매(18.3％),폐포세포불전형증생(AAH)7매(ll.8％),염성육아종4매(6.7％),착구류3매(5.0％),결핵성육아종2매(3.3％).결론 흉강경술전CT인도하아갑람여Hookwire연합정위준학솔고,대흉강경수술(VATS)설형절제병조유겁대적방조작용,구유량호적림상응용개치.
Objective To evaluate the clinical application of CT-guided localization with combination of methylene blue and a Hookwire system for small pulmonary nodules (SPNs) before video-assisted thoracoscopic resection.Methods CTguided localization the SPNs before resection in 56 patients and 60 nodules,then underwent video-assisted thoracic surgery (VATS) resection.Among 56 patients,19 males and 37 females,aged from 35 to 81 years,mean age was (61.1 ±8.9)years.Results SPNs diameter (6.80 ±4.12) mm,distance from the parietal pleura (15.38 ±4.63) mm.CT-guided localization success rate was 100％,positioning time (10.76 ± 8.17) min,8.9％ (5/56) had micro pneumothorax aftet positioning,7.1％ (4/56) occurrence of needle tract bleeding,no conservative treatment.VATS resection rate was 100％.The pathology of 60 lesions were shown:Bronchiolo-alveolar carcinoma(BAC) were 33 lesions(55.0％),BAC and adenocarcinoma were 11 lesions(18.3％),Atypicaladenomatous hyperplasia (AAH) were 7 lesions (11.8％),Inflammation were 4 lesions (6.7％),Harmatoma were 3 lesions(5.0％),Tuberculoses were 2 lesions(3.3％).Conclusion CT-guided localization with combination of methylene blue and a Hookwire system before video-assisted thoracoscopic resection is a promising technique for small solitary pulmonary nodules.It could play an important role in accurate localization of small pulmonary nodules,and it is a safe technique with clinical application.
