计算机断层扫描三维重建联合带钩钢丝定位对ⅠA期肺癌的诊疗价值研究

目的探讨计算机断层扫描(CT)三维重建联合带钩钢丝(Hookwire)定位在ⅠA期肺癌诊疗中的应用效果。方法选取94例孤立性肺结节(SPN)患者作为研究对象,根据术后病理分为恶性SPN组(60例)和良性SPN组(34例)。记录并比较两组患者术前病灶影像学特征,记录患者电视胸腔镜手术(VATS)手术情况,包括手术时间、术中出血量、住院时间及Hookwire定位操作和VATS手术相关并发症。结果良恶性SPN病灶血管集束征、空泡征及左右肺分布比例比较,差异均无统计学意义(P﹥0.05)。恶性SPN边界不规则、毛刺征、分叶征、胸膜凹陷征、内部钙化灶和肺上叶比例均高于良性SPN病灶,差异均有统计学意义(P﹤0.05)。Hookwire定位针首次定位成功率为98.94%(93/94),二次定位成功率为100%。术中发现定位针脱落2例(2.13%),VATS楔形切除手术成功率为98.94%,1例因胸膜粘连严重转行微创开胸手术。VATS楔形切除手术时间为(20.75±8.22)min,术中出血量(26.58±9.43)ml,术后住院时间(5.45±2.16)d。定位操作和术后并发症发生率分别为17.02%(16/94)和4.26%(4/94)。结论CT三维重建联合Hookwire定位较好地解决了ⅠA期肺癌精准定位切除的问题,但也存在定位针脱落等风险,仍需进一步研究论证。

The value of 3-dimensional computed tomography reconstruction combined with Hookwire localization in the diagnosis and treatment of stage ⅠA lung cancer

Objective To explore the effect of 3-dimensional(3D) computed tomography(CT) reconstruction combined with Hookwire localization in the diagnosis and treatment of stage ⅠA lung cancer. Method A total of 94 patients with solitary pulmonary nodule(SPN) were included in the study and were grouped by the postoperative pathological findings into malignant SPN group(n=60) and benign SPN group(n=34). The imaging features of the lesions in the two groups before surgery were recorded and compared, indicators of video-assisted thoracoscopic surgery(VATS), including operative time, intraoperative blood loss, hospitalization time, complications related to Hookwire localization and VATS were recorded. Result There was no significant difference with respect to about the presence of vascular convergence,vacuole sign and distribution in left and right pulmonary lobules between benign and malignant SPN lesions(P>0.05).Higher proportion of irregular boundary, spiculation, lobulation, pleural indentation, internal calcification and upper lobe SPN was observed in malignant SPN versus benign SPN lesions, the differences were statistically significant(P<0.05).The success rate of first Hookwire localization was 98.94%(93/94), and attained 100% success rate for the second localization. During the operation, 2 cases(2.13%) were found to have wire displacement, 98.94% patients had successful VATS wedge resection, and 1 case switched to minimally invasive thoracotomy due to severe pleural adhesion. The time of VATS wedge resection was(20.75±8.22) min, intraoperative blood loss was(26.58±9.43) ml, and postoperative length of hospital stay was(5.45 ± 2.16) d. The incidence of complications related to Hookwire localization and VATS was 17.02%(16/94) and 4.26%(4/94), respectively. Conclusion 3 D reconstruction combined with Hookwire localization via CT fairly addresses the challenge of accurate localization and resection of stage ⅠA lung cancer, while is still faced with risks of wire displacement, which warrants further study to investigate.