CAJ | 학술논문

背景与目的肺小结节尤其是磨玻璃结节（ground glass opacity, GGO）病灶的定位是微创手术切除的难点，报道的方法很多但均有不足。本研究旨在探讨计算机断层扫描（computed tomography, CT）引导下Hook-wire术前定位在胸腔镜下（video-assisted thoracoscopic surgery, VATS）肺结节切除术中的临床应用价值，并初步探讨GGOs积极微创手术治疗的必要性和可行性。方法2013年5月-2015年6月共25例患者的26枚肺结节于术前行CT引导下Hook-wire定位，然后施行胸腔镜楔形切除术。统计Hook-wire定位时间、成功率、并发症及楔形切除时间、住院时间等，计算病灶组织学分型中的恶性几率，讨论肺部GGOs积极手术治疗的必要性。结果共25例患者26个结节（男性10例，女性15例，6个实性结节，20个GGOs），病灶直径5 mm-20 mm（平均8 mm），病灶距离胸膜垂直距离5 mm-30 mm（平均14 mm），CT引导下Hook-wire定位成功率为100%。VATS楔形切除术成功率为100%。CT定位时间平均10 min（5 min-15 min），微创切除病灶所需时间平均20 min（15 min-40 min），平均住院时间为4 d（3 d-6 d）。4例患者定位后发生微量气胸，但无需闭式引流处理。术中定位针脱落1例，但仍于胸腔镜下观察到穿刺点脏层胸膜下血肿后，准确定位并成功切除。20个GGOs术后组织学诊断结果为：16个混合性GGOs（mixed GGO, mGGO）中，微浸润腺癌2例，腺癌5例，小细胞肺癌（small cell lung cancer, SCLC）1例，炎性病灶8例；4个纯GGOs（pure GGO, pGGO）中原位腺癌1例，非典型性腺瘤样增生（atypical adenomatoid hyperplasia, AAH）1例，炎性病灶2例。结论 CT引导下Hook-wire肺结节尤其是GGOs术前定位准确率高，相关并发症轻微，是一种安全、有效的方法，能快速确定下一步诊疗方案，值得临床推广；肺部mGGOs是恶性病灶的几率很大，积极微创手术治疗是非常必要的。揹景與目的肺小結節尤其是磨玻璃結節（ground glass opacity, GGO）病竈的定位是微創手術切除的難點，報道的方法很多但均有不足。本研究旨在探討計算機斷層掃描（computed tomography, CT）引導下Hook-wire術前定位在胸腔鏡下（video-assisted thoracoscopic surgery, VATS）肺結節切除術中的臨床應用價值，併初步探討GGOs積極微創手術治療的必要性和可行性。方法2013年5月-2015年6月共25例患者的26枚肺結節于術前行CT引導下Hook-wire定位，然後施行胸腔鏡楔形切除術。統計Hook-wire定位時間、成功率、併髮癥及楔形切除時間、住院時間等，計算病竈組織學分型中的噁性幾率，討論肺部GGOs積極手術治療的必要性。結果共25例患者26箇結節（男性10例，女性15例，6箇實性結節，20箇GGOs），病竈直徑5 mm-20 mm（平均8 mm），病竈距離胸膜垂直距離5 mm-30 mm（平均14 mm），CT引導下Hook-wire定位成功率為100%。VATS楔形切除術成功率為100%。CT定位時間平均10 min（5 min-15 min），微創切除病竈所需時間平均20 min（15 min-40 min），平均住院時間為4 d（3 d-6 d）。4例患者定位後髮生微量氣胸，但無需閉式引流處理。術中定位針脫落1例，但仍于胸腔鏡下觀察到穿刺點髒層胸膜下血腫後，準確定位併成功切除。20箇GGOs術後組織學診斷結果為：16箇混閤性GGOs（mixed GGO, mGGO）中，微浸潤腺癌2例，腺癌5例，小細胞肺癌（small cell lung cancer, SCLC）1例，炎性病竈8例；4箇純GGOs（pure GGO, pGGO）中原位腺癌1例，非典型性腺瘤樣增生（atypical adenomatoid hyperplasia, AAH）1例，炎性病竈2例。結論 CT引導下Hook-wire肺結節尤其是GGOs術前定位準確率高，相關併髮癥輕微，是一種安全、有效的方法，能快速確定下一步診療方案，值得臨床推廣；肺部mGGOs是噁性病竈的幾率很大，積極微創手術治療是非常必要的。
배경여목적폐소결절우기시마파리결절（ground glass opacity, GGO）병조적정위시미창수술절제적난점，보도적방법흔다단균유불족。본연구지재탐토계산궤단층소묘（computed tomography, CT）인도하Hook-wire술전정위재흉강경하（video-assisted thoracoscopic surgery, VATS）폐결절절제술중적림상응용개치，병초보탐토GGOs적겁미창수술치료적필요성화가행성。방법2013년5월-2015년6월공25례환자적26매폐결절우술전행CT인도하Hook-wire정위，연후시행흉강경설형절제술。통계Hook-wire정위시간、성공솔、병발증급설형절제시간、주원시간등，계산병조조직학분형중적악성궤솔，토론폐부GGOs적겁수술치료적필요성。결과공25례환자26개결절（남성10례，녀성15례，6개실성결절，20개GGOs），병조직경5 mm-20 mm（평균8 mm），병조거리흉막수직거리5 mm-30 mm（평균14 mm），CT인도하Hook-wire정위성공솔위100%。VATS설형절제술성공솔위100%。CT정위시간평균10 min（5 min-15 min），미창절제병조소수시간평균20 min（15 min-40 min），평균주원시간위4 d（3 d-6 d）。4례환자정위후발생미량기흉，단무수폐식인류처리。술중정위침탈락1례，단잉우흉강경하관찰도천자점장층흉막하혈종후，준학정위병성공절제。20개GGOs술후조직학진단결과위：16개혼합성GGOs（mixed GGO, mGGO）중，미침윤선암2례，선암5례，소세포폐암（small cell lung cancer, SCLC）1례，염성병조8례；4개순GGOs（pure GGO, pGGO）중원위선암1례，비전형성선류양증생（atypical adenomatoid hyperplasia, AAH）1례，염성병조2례。결론 CT인도하Hook-wire폐결절우기시GGOs술전정위준학솔고，상관병발증경미，시일충안전、유효적방법，능쾌속학정하일보진료방안，치득림상추엄；폐부mGGOs시악성병조적궤솔흔대，적겁미창수술치료시비상필요적。
Background and objective Localization of pulmonary ground glass nodule is the technical diffculty of minimally invasive operation resection. hTe aim of this study is to evaluate the value of computed tomography (CT)-guided Hook-wire precise localization in resection of pulmonary nodules by video-assisted thoracoscopic surgery (VATS) as well as to discuss the necessity and feasibility of surgical resection of GGOs through a minimally invasive approach.Methods CT-guided Hook-wire precise localization and wedge resection was done on 25 cases with 26 pulmonary nodules by VATS from May 2013 to June 2015. hTe effcacy of localization was evaluated in terms of procedure time, VATS success rate, and associated complications of localization.Results All the 26 pulmonary nodules (6 solid nodules and 20 GGOs ) of 25 patients (10 males and 15 females) were preoperatively detected and localized with Hook-wire under CT guidance. Nodule diameters ranged from 5 mm-20 mm (mean: 8 mm). hTe distance of lung lesions from the nearest pleural surfaces ranged within 5 mm-30 mm (mean: 14 mm). All resections of lesions guided by the Hook-wire were successfully performed by VATS (success rate: 100%). hTe mean procedure time for the CT-guided Hook-wire localization was 10 min (range: 5 min-10 min). hTe mean procedure time for VATS wedge resection was 20 min (range: 15 min-40 min). hTe mean hospital time was 4 d (range: 3 d-6 d). hTe major complication of CT-guided Hook-wire localization was mild pneumothorax in 4 patients, but no one needed chest tube drain-age. Wedge resection was performed successfully in all cases. hTe dislocation of Hook-wire was found in only one patient dur-ing the operation, but the lesion was still successfully resected under VATS. Results of pathological examination of 16 mGGOs revealed 8 primary lung cancers and 8 nonspeciifc chronic inlfammations. Results of pathological examination of 4 pGGOs re-vealed 1 primary lung cancers, 1 atypical adenomatous hyperplasia (AAH), and 2 nonspeciifc chronic inlfammations.Conclu-sion hTe preoperative CT-guided Hook-wire localization for pulmonary nodules particularly for GGOs is an effective and safe technique to assist VATS resection of the nodules. It can increase the ratio of lung wedge resection with little complications and may be better used in clinical diagnosis and treatment of small pulmonary nodules with VATS. Lung mGGOs carry a high risk of malignancy. Aggressive surgical resection of these mGGOs is necessary and feasible.