CAJ | 학술논문

目的：评价术中应用 CT 引导下穿刺定位后行单操作孔胸腔镜切除 CT 病灶直径＜1．5 cm且胸膜无明显改变的磨玻璃样小结节的临床效果。方法2009年8月至2014年9月共15例肺磨玻璃样小结节患者，手术室内麻醉、体位固定后行术中 CT 引导下带钩钢丝针穿刺定位，随即行胸腔镜切除术。评价术中 CT 引导下穿刺定位技术的准确性、并发症、单操作孔胸腔镜手术切除率及病理结果等。结果15个磨玻璃样小结节均在术中 CT 引导下穿刺定位明确并行单操作孔胸腔镜切除术。术中 CT 定位成功率100％，平均定位时间（13．60±2．06）min，仅1例穿刺后出现少量气胸。单操作孔胸腔镜手术切除率为100％，其中肺叶切除1例，肺段切除1例，局部切除13例。术后病理诊断结果：原位腺癌9例，不典型腺瘤样增生（AAH）5例，AAH 合并原位腺癌1例。术后随访患者均存活，无复发、转移征象。结论术中麻醉下应用 CT 引导能准确将 CT 直径＜1．5 cm 且胸膜无明显改变的磨玻璃样小结节行穿刺定位，并能联合单操作孔胸腔镜将其切除，准确、快捷、安全，具有很好的临床价值。
목적：평개술중응용 CT 인도하천자정위후행단조작공흉강경절제 CT 병조직경＜1．5 cm차흉막무명현개변적마파리양소결절적림상효과。방법2009년8월지2014년9월공15례폐마파리양소결절환자，수술실내마취、체위고정후행술중 CT 인도하대구강사침천자정위，수즉행흉강경절제술。평개술중 CT 인도하천자정위기술적준학성、병발증、단조작공흉강경수술절제솔급병리결과등。결과15개마파리양소결절균재술중 CT 인도하천자정위명학병행단조작공흉강경절제술。술중 CT 정위성공솔100％，평균정위시간（13．60±2．06）min，부1례천자후출현소량기흉。단조작공흉강경수술절제솔위100％，기중폐협절제1례，폐단절제1례，국부절제13례。술후병리진단결과：원위선암9례，불전형선류양증생（AAH）5례，AAH 합병원위선암1례。술후수방환자균존활，무복발、전이정상。결론술중마취하응용 CT 인도능준학장 CT 직경＜1．5 cm 차흉막무명현개변적마파리양소결절행천자정위，병능연합단조작공흉강경장기절제，준학、쾌첩、안전，구유흔호적림상개치。
Objective To evaluate the clinical effect of CT guided localization with a hook-wire system united with single port video-assisted thoracoscopic resection (VATS)for small ground glass opacity (GGO) pulmonary nodules (CT lesion diameter <1 .5 cm and no pleural changes).Methods Fifteen patients with small GGO pulmonary nodules who underwent CT-guided transthoracic localization with a hook-wire system in operation room after anesthesia were performed with single port VATS from August 2009 to March 201 3.The accuracy of puncture location,complications,resection rate and pathological results were evaluated.Results All patients underwent CT-guided hook-wire localization and single port VATS resection.The success rate of localization was 1 00%,and the average procedure time was (1 3.60 ±2.06)min,only 1 patient occurred mini-mal pneumothorax.The resection rate of single port VATS was 1 00%,and lobectomy performed in 1 patient, segmentectomy in 1 ,and local resection in 1 3.Pathological diagnosis:adenocarcinoma in situ in 9,atypical adenomatous hyperplasia (AAH)in 5,AAH and adenocarcinoma in situ in 1 .Post-operation follow-up showed all patients survived,and no recurrence and metastasis.Conclusion In operation,use of CT guided localiza-tion with a hook-wire system for small GGO pulmonary nodules (CT lesion diameter <1 .5 cm and no pleural changes)united with video-assisted thoracoscopic resection is accurate,quick and safe,and it has good clinical value.