CAJ | 학술논문

背景与目的肺磨玻璃样微小结节（ground glass opacity, GGO）病灶的定位是微创手术切除的技术难点。各种定位方法均有报道，但每一种方法均有其不足。本研究拟通过评价术中CT引导下Hook-wire定位对GGO微创切除的价值，初步探索肺部<10 mm的GGO积极手术治疗的必要性和可行性。方法2009年10月-2013年10月共32例GGO患者，41个GGO，行胸腔镜微创切除术，麻醉插管后皆在手术体位下行计算机断层扫描（computed tomography, CT）CT引导Hook-wire定位。记录术中CT引导下Hook-wire定位技术的失败率、并发症、胸腔镜手术转为开胸手术的几率、住院时间等，计算病灶组织学分型中的恶性几率，讨论肺部<10 mm的GGO积极手术治疗的必要性。结果共32例患者（男性15例，女性17例）行41个GGO胸腔镜微创切除术，其中2个病灶、3个病灶和5个病灶同时微创切除患者数量分别是3例、1例、1例。病灶直径2 mm-10 mm（平均5 mm），病灶距离胸膜垂直距离5 mm-24 mm（平均12.5 mm）。术中CT引导下Hook-wire定位成功率100%，严重并发症发生率0，转化为开胸手术比率为0，CT定位时间平均8.4 min（4 min-18 min），微创切除病灶所需时间平均32 min（14 min-98 min），中位住院时间为8 d（5 d-14 d）。GGOs术后组织学诊断结果为：原位腺癌（肺泡癌）19例，约46.3%，腺癌8例，约19.5%，大细胞癌1例，约2.4%，不典型腺瘤样增生9例，约22%，炎性病灶4例，约9.8%。结论肺部GGO是恶性病灶的几率很大，对典型GGO患者积极微创手术治疗是非常必要的；术中CT引导下Hook-wire定位技术极大提高GGO微创切除可行性、并发症发生率低，对于GGO的鉴别诊断及治疗具有很好的临床价值。
배경여목적폐마파리양미소결절（ground glass opacity, GGO）병조적정위시미창수술절제적기술난점。각충정위방법균유보도，단매일충방법균유기불족。본연구의통과평개술중CT인도하Hook-wire정위대GGO미창절제적개치，초보탐색폐부<10 mm적GGO적겁수술치료적필요성화가행성。방법2009년10월-2013년10월공32례GGO환자，41개GGO，행흉강경미창절제술，마취삽관후개재수술체위하행계산궤단층소묘（computed tomography, CT）CT인도Hook-wire정위。기록술중CT인도하Hook-wire정위기술적실패솔、병발증、흉강경수술전위개흉수술적궤솔、주원시간등，계산병조조직학분형중적악성궤솔，토론폐부<10 mm적GGO적겁수술치료적필요성。결과공32례환자（남성15례，녀성17례）행41개GGO흉강경미창절제술，기중2개병조、3개병조화5개병조동시미창절제환자수량분별시3례、1례、1례。병조직경2 mm-10 mm（평균5 mm），병조거리흉막수직거리5 mm-24 mm（평균12.5 mm）。술중CT인도하Hook-wire정위성공솔100%，엄중병발증발생솔0，전화위개흉수술비솔위0，CT정위시간평균8.4 min（4 min-18 min），미창절제병조소수시간평균32 min（14 min-98 min），중위주원시간위8 d（5 d-14 d）。GGOs술후조직학진단결과위：원위선암（폐포암）19례，약46.3%，선암8례，약19.5%，대세포암1례，약2.4%，불전형선류양증생9례，약22%，염성병조4례，약9.8%。결론폐부GGO시악성병조적궤솔흔대，대전형GGO환자적겁미창수술치료시비상필요적；술중CT인도하Hook-wire정위기술겁대제고GGO미창절제가행성、병발증발생솔저，대우GGO적감별진단급치료구유흔호적림상개치。
Background and objective Localization of pulmonary ground glass small nodule is the technical dif-ficulty of minimally invasive operation resection. The aim of this study is to evaluate the value of intraoperative computed tomography (CT)-guided localization using a hook-wire system for small ground glass opacity (GGO) in minimally invasive resection, as well as to discuss the necessity and feasibility of surgical resection of small GGOs (<10 mm) through a minimally invasive approach.MethodshTe records of 32 patients with 41 small GGOs who underwent intraoperative CT-guided double-thorn hook wire localization prior to video-assisted thoracoscopic wedge resection from October 2009 to October 2013 were retrospectively reviewed. All patients received video-assisted thoracoscopic surgery (VATS) within 10 min atfer wire localiza-tion. hTe effcacy of intraoperative localization was evaluated in terms of procedure time, VATS success rate, and associated complications of localization.Results A total of 32 patients (15 males and 17 females) underwent 41 VATS resections, with 2 simultaneous nodule resections performed in 3 patients, 3 lesion resections in 1 patient, and 5 lesions in a patient. Nodule di-ameters ranged from 2 mm-10 mm (mean: 5 mm). hTe distance of lung lesions from the nearest pleural surfaces ranged within 5 mm-24 mm (mean: 12.5 mm). All resections of lesions guided by the inserted hook wires were successfully performed by VATS (100% success rate). hTe mean procedure time for the CT-guided hook wire localization was 8.4 min (range: 4 min-18 min). hTe mean procedure time for VATS was 32 min (range: 14 min-98 min). hTe median hospital time was 8 d (range: 5 d-14 d). Results of pathological examination revealed 28 primary lung cancers, 9 atypical adenomatous hyperplasia, and 4 nonspe-ciifc chronic inlfammations. No major complication related to the intraoperative hook wire localization and VATS was noted. Conclusion Intraoperative CT-guided hook wire localization is useful, particularly in small GGO localization in VATS wedge resection and has a signiifcantly low rate of minor complications. Lung GGOs carry a 90% risk of malignancy. Aggressive surgi-cal resection of these GGOs is necessary and feasible through the guidance of intraoperative CT localization technique.