医学研究生学报
醫學研究生學報
의학연구생학보
JOURNAL OF MEDICAL POSTGRADUATE
2015年
2期
153-156
,共4页
强勇%杨楠%许建%熊磊%易俊%钱建军%罗立国%董国华%申翼%李德闽%李忠东
彊勇%楊楠%許建%熊磊%易俊%錢建軍%囉立國%董國華%申翼%李德閩%李忠東
강용%양남%허건%웅뢰%역준%전건군%라입국%동국화%신익%리덕민%리충동
孤立性肺结节%DSA实时导向%电视胸腔镜手术%血管栓塞弹簧圈
孤立性肺結節%DSA實時導嚮%電視胸腔鏡手術%血管栓塞彈簧圈
고립성폐결절%DSA실시도향%전시흉강경수술%혈관전새탄황권
Solitary pulmonary nodule%Real-time digital subtraction angiography%Video-assisted thracoscopic surgery%Coil localization
目的：肺部结节在手术中的定位一直是临床中的难题。文中讨论CT引导下弹簧圈定位结合数字减影血管造影术（digital subtraction angiography ， DSA）实时导向电视胸腔镜手术（video-assisted thoracoscopic surgery， VATS）精准切除孤立性肺结节（ solitary pulmonary nodule ， SPN）的诊疗价值。方法收集2011年9月至2014年5月间南京军区南京总医院心胸外科收治的SPN患者82例。患者均于手术当天在CT引导下经皮穿刺，紧贴病灶放置金属弹簧圈定位，随后送入杂交手术室。术中结合DSA实时导向行VATS楔形切除SPN，再根据术中快速病理结果行下一步处理。结果金属弹簧圈定位成功率100％，平均定位时间（15．3±3．2）min，VATS楔形平均切除手术时间（24．2±12．1）min，术后病理结果显示恶性病变45例、良性病变37例，无严重并发症。结论 SPN在术前CT引导下置入弹簧圈标记定位准确率高。结合DSA实时导向行VATS切除可精准切除病灶，并确保切缘距离病灶2 cm以上，达到SPN诊治一体化的目的。
目的：肺部結節在手術中的定位一直是臨床中的難題。文中討論CT引導下彈簧圈定位結閤數字減影血管造影術（digital subtraction angiography ， DSA）實時導嚮電視胸腔鏡手術（video-assisted thoracoscopic surgery， VATS）精準切除孤立性肺結節（ solitary pulmonary nodule ， SPN）的診療價值。方法收集2011年9月至2014年5月間南京軍區南京總醫院心胸外科收治的SPN患者82例。患者均于手術噹天在CT引導下經皮穿刺，緊貼病竈放置金屬彈簧圈定位，隨後送入雜交手術室。術中結閤DSA實時導嚮行VATS楔形切除SPN，再根據術中快速病理結果行下一步處理。結果金屬彈簧圈定位成功率100％，平均定位時間（15．3±3．2）min，VATS楔形平均切除手術時間（24．2±12．1）min，術後病理結果顯示噁性病變45例、良性病變37例，無嚴重併髮癥。結論 SPN在術前CT引導下置入彈簧圈標記定位準確率高。結閤DSA實時導嚮行VATS切除可精準切除病竈，併確保切緣距離病竈2 cm以上，達到SPN診治一體化的目的。
목적：폐부결절재수술중적정위일직시림상중적난제。문중토론CT인도하탄황권정위결합수자감영혈관조영술（digital subtraction angiography ， DSA）실시도향전시흉강경수술（video-assisted thoracoscopic surgery， VATS）정준절제고립성폐결절（ solitary pulmonary nodule ， SPN）적진료개치。방법수집2011년9월지2014년5월간남경군구남경총의원심흉외과수치적SPN환자82례。환자균우수술당천재CT인도하경피천자，긴첩병조방치금속탄황권정위，수후송입잡교수술실。술중결합DSA실시도향행VATS설형절제SPN，재근거술중쾌속병리결과행하일보처리。결과금속탄황권정위성공솔100％，평균정위시간（15．3±3．2）min，VATS설형평균절제수술시간（24．2±12．1）min，술후병리결과현시악성병변45례、량성병변37례，무엄중병발증。결론 SPN재술전CT인도하치입탄황권표기정위준학솔고。결합DSA실시도향행VATS절제가정준절제병조，병학보절연거리병조2 cm이상，체도SPN진치일체화적목적。
Objective The localization of pulmonary nodules in surgery remains a clinical challenge .In this study we dis-cussed the diagnostic and treatment value of CT-guided coil localization followed by real-time digital subtraction angiography ( DSA)-guided accurate resection of solitary pulmonary nodules (SPN) with video-assisted thracoscopic surgery (VATS). Methods This study involved 82 cases of SPN treated in the Department of Cardiothoracic Surgery of Jinling Hospital from September 2011 to May 2014 .The SPNs were preoperatively positioned by placing a metal coil close to the lesion under CT guidance on the same day of surger -y.Then VATS wedge resection of the SPNs was performed under the guidance of real -time DSA and further procedures followed in ac-cordance with the results of intraoperative pathology . Results The success rate of coil localization was 100%, the mean time of po-sitioning was (15.3 ±3.2) min, and the mean time of VATS wedge resection was (24.2 ±12.1) min.Pathological results revealed 45 cases of malignancy and 37 cases of benign lesions . Conclusion Preoperative CT-guided coil localization of SPNs showed a high accuracy and no serious complications , and by real-time DSA-guided VATS that immediately followed , the nodules could be precisely removed with the cutting edge 2 cm above the lesion , which achieved both the purposes of diagnosis and treatment of SPNs .
