CT引导下弹簧圈定位在肺小结节(直径≤15 mm)单操作孔胸腔镜手术中应用的回顾性队列研究

目的探讨CT引导下弹簧圈定位在肺小结节(直径≤15 mm)手术中的应用价值。方法回顾性分析2018年8月至2019年12月在南京鼓楼医院行单操作孔胸腔镜手术治疗175例肺小结节患者的临床资料。根据术前是否行CT引导下弹簧圈定位将患者分为定位组84例,其中男34例、女50例,年龄(57.8±8.8)岁]和非定位组91例,其中男46例、女45例,年龄(57.6±10.8)岁]。对定位成功率、定位时间、并发症发生率、手术及术后情况等相关指标进行统计分析。结果定位组84例患者均定位成功,定位时间为(19.0±3.6)min。发生少量气胸19例(22.6%)、肺内出血4例(4.8%)、弹簧圈移位2例(2.4%);轻度疼痛6例(7.1%)、中度疼痛3例(3.6%)、重度疼痛1例(1.2%)。两组性别(P=0.181)、年龄(P=0.673)、结节位置(P=0.167)、病变性质(P=0.244)、胸腔镜手术中转开胸率(P=0.414)、结节一次性切除率(P=0.251)、术后住院时间(P=0.207)方面差异无统计学意义;结节大小(P<0.001)、结节性质(P<0.001)、结节到肺表面的最短距离(P<0.001)、手术时间(P<0.001)、楔形切除肺组织体积(P=0.031),闭合器钉仓数量(P<0.001)、住院总费用(P<0.001)方面差异有统计学意义。结论CT引导下弹簧圈定位具有定位成功率高、简单易行、精准有效、安全微创等特点。术前行CT引导下弹簧圈定位,对于肺小结节手术,特别是结节小、位置深且实性成分少的结节,具有重要的临床应用价值,能够有效缩短手术时间、减少手术创伤、降低住院费用,是一种值得推广的术前定位技术。

Application of CT-guided microcoil localization in single utility port video-assisted thoracoscopic surgery for small pulmonary nodules(diameter≤15 mm):A retrospective cohort study

Objective To explore the application value of CT-guided microcoil localization in pulmonary nodule(diameter≤15 mm)surgery.Methods The clinical data of 175 patients with pulmonary nodules who underwent single utility port video-assisted thoracoscopic surgery at Nanjing Drum Tower Hospital from August 2018 to December 2019 were retrospectively analyzed.According to whether CT-guided coil localization was performed before operation,they were divided into a locating group and a non-locating group.There were 84 patients(34 males,50 females,aged 57.8±8.8 years)in the locating group and 91 patients(46 males,45 females,aged 57.6±10.8 years)in the non-locating group.The localization success rate,localization time,incidence of complications,surgical and postoperative conditions were analyzed between the two groups.Results All 84 patients in the locating group were successfully located,and localization time was 19.0±3.6 minutes.Among them,19(22.6%)patients had a small pneumothorax,4(4.8%)pulmonary hemorrhage and 2(2.4%)coil shift;6(7.1%)patients had mild pain,3(3.6%)moderate pain and 1(1.2%)severe pain.Sex(P=0.181),age(P=0.673),nodule location(P=0.167),nature of lesion(P=0.244),rate of conversion to thoracotomy(P=0.414),rate of disposable resection of nodules(P=0.251)and postoperative hospital stay(P=0.207)were similar between the two groups.There were significant differences in nodule size(P<0.001),nature of nodule(P<0.001),the shortest distance from nodule to pleura(P<0.001),operation time(P<0.001),lung volume by wedge resection(P=0.031),number of staplers(P<0.001)and total hospitalization costs(P<0.001)between the two groups.Conclusion CT-guided microcoil localization has the characteristics of high success rate,and is simple,practicable,effective,safe and minimally invasive.Preoperative CT-guided microcoil localization has important clinical application value for small pulmonary nodules,especially those with small size,deep location and less solid components.It can effectively shorten the operation time,reduce surgical trauma and lower hospitalization costs,which is a preoperative localization technique worthy of popularization.