电视胸腔镜手术前CT引导下亚甲蓝和/或Hookwire定位肺磨玻璃结节

目的 探讨肺磨玻璃结节（GGN）电视胸腔镜手术（VATS）前CT引导下亚甲蓝染色和/或Hookwire定位结节的临床价值。方法 对141例肺GGN患者（160枚结节）均在CT引导下亚甲蓝染色和/或Hookwire定位结节后行VATS,计算定位成功率、穿刺并发症发生率及手术成功率。结果 141例均成功定位并切除肺GGN。单独亚甲蓝染色定位18枚,Hookwire定位12枚,二者联合定位130枚,定位成功率均为100%。穿刺过程中少量肺出血25例,气胸38例,肺出血并发气胸13例。术后病理示恶性结节117枚,良性结节43枚。结论 对肺GGN行VATS术前CT引导下亚甲蓝染色和/或Hookwire均可准确定位结节,有助于减少穿刺并发症、提高切除成功率。     

CT引导下带钩钢丝精准定位肺磨玻璃结节在胸腔镜术前的应用及并发症的分析

目的:探讨肺磨玻璃结节胸腔镜术前行CT引导下带钩钢丝精准定位的临床应用及并发症的分析。方法:收集28例患者34枚肺磨玻璃结节行CT引导下带钩钢丝精准定位,并行胸腔镜下肺结节切除术的资料。结果:CT引导下定位成功率为100%,定位时间约为(19.15±6.23)min。6例患者出现少量气胸,3例患者出现带钩钢丝周围少量出血,均无需临床进行相关处理;2例患者于胸腔镜手术时发现带钩钢丝滑脱出肺组织外,但术者经穿刺点肺表面出血点成功完成了肺楔形切除。VATS肺楔形切除术成功率为100%。结论:CT引导下带钩钢丝精准定位是一种安全、有效的术前定位方法,在VATS术中可协助术者快速、准确切除肺磨玻璃结节,其并发症偶有发生,但多较轻微且无需进行处理,值得推广。     

CT引导Brell定位胸腔镜下肺小结节21例治疗体会

目的探讨CT引导Brell定位肺小结节胸腔镜手术临床价值。方法对2008-10-2010-08共21例肺小结节CT下Brell(带倒钩金属导丝定位针)定位。结果 15~35 min后行胸腔镜下肺楔形切除术14例,胸腔镜辅助小切口肺叶切除3例,中转开胸手术4例,术前C T引导下导丝定位成功率100%,穿刺定位并发症发生率19.1%,中转开胸手术比率为19.1%,病理结果原发性肺癌8例,肺转移瘤2例,肺错构瘤2例,肺结核球1例,肺炎性结节8例。恶性结节确诊率38.1%。结论 CT下导丝定位胸腔镜下肺小结节诊治准确可行。     

CT引导下微弹簧圈和亚甲蓝联合定位在肺部小结节胸腔镜手术中的应用

目的探讨CT引导下微弹簧圈和亚甲蓝联合定位在肺部小结节胸腔镜手术(VATS)中的应用价值。方法47例患者(52枚肺部小结节)经CT引导微弹簧圈加亚甲蓝联合定位后行VATS手术,分析定位成功率、定位时间及并发症发生情况。结果肺结节定位成功率为100. 0%,定位时间为(16. 5±4. 3) min,定位后出现无症状少量气胸8例,穿刺针道出血6例,少量气胸合并针道出血4例,无血胸、空气栓塞等并发症。所有患者均行胸腔镜手术,术中无中转开胸患者。结论肺结节VATS术前经CT引导下微弹簧圈和亚甲蓝联合定位准确性高、并发症少。     

CT引导Hook-wire定位在孤立性肺结节胸腔镜治疗中的应用及护理

目的研究CT引导Hook-wire定位穿刺在孤立性肺结节胸腔镜手术前的应用及围手术期护理措施。方法回顾性分析我院2009年1月-2016年5月间采用胸腔镜手术切除孤立性肺结节患者共65例,所有患者胸腔镜术前行CT引导Hook-wire定位穿刺,总结其护理要点。结果所有病例均穿刺定位成功,术后并发无症状性气胸9例,少量出血6例,经积极对症治疗及护理后症状缓解;穿刺术后定位针脱落2例,胸外科手术医师根据定位钩丝局部穿刺血肿找到并有效切除病灶。结论孤立性肺结节胸腔镜术前行CT引导Hook-wire定位穿刺简单、安全、有效,穿刺前完善的准备,穿刺中的密切观察及有效的护理能有效提高穿刺成功率,减少术后并发症。     

CT诊断肺朗格汉斯细胞组织细胞增生症

目的 探讨肺朗格汉斯细胞组织细胞增生症(PLCH)的CT表现。方法 回顾性分析10例经病理证实PLCH患者的临床资料及CT影像资料,分析病变的分布、大小和形态等CT特征。结果 单系统(SS)朗格汉斯细胞组织细胞增生症(LCH) 7例,其中早期1例,中晚期6例;多系统(MS)LCH 3例,其中早期1例,中晚期2例。10例病变均呈弥漫、对称性分布,并以中上肺野分布为主。2例早期PLCH患者CT表现以多发小叶中央性结节为主,并见厚壁或薄壁空洞结节;8例中晚期患者,CT表现以囊腔为主,为圆形或类圆形囊腔、形态多样的融合囊腔合并/不合并少量结节、空洞结节,其中2例融合性囊腔形成肺大疱,并破裂产生气胸。结论 双侧中上肺野多发小叶中心性分布结节、空洞结节,合并囊腔,特别是形态多样的囊腔为PLCH的CT特征表现。     

CT引导单双钩Hook-wire定位在胸腔镜手术中的应用研究

目的 探讨术前CT引导下单钩与双钩Hook-wire定位技术在肺小结节胸腔镜切除术中的应用价值.方法 选取拟行胸腔镜肺楔形切除术的98例125处肺小结节患者.采用随机数字表法将其分为单钩组与双钩组,单钩组49例患者64处病灶接受术前CT引导下单钩Hook-wire定位,双钩组49例患者61处病灶则接受双钩Hook-wi...     

三代双源CT Sn 100 kVp能谱纯化成像用于引导经皮穿刺肺活检

目的 观察三代双源CT Sn 100 kVp能谱纯化成像引导经皮穿刺肺活检的效能、安全性及辐射剂量。方法 前瞻性随机将210例孤立性肺结节穿刺患者分入超低剂量CT(ULDCT)组(100例,以Sn 100 kVp、70 mAs超低剂量能谱纯化技术CT引导肺穿刺活检)或常规标准剂量CT(SDCT)组(110例,以110 kVp、50 mAs常规标准剂量CT引导肺穿刺活检),比较2组肺结节穿刺活检取材成功率、诊断效能、并发症发生率、图像质量及辐射剂量。结果 ULDCT组穿刺活检取材成功率为97.00%,与SDCT组(98.18%)差异无统计学意义 (P＞0.05)。组间取材成功后诊断敏感度、特异度、准确率及并发症发生率差异均无统计学意义(P均＞0.05)。相比SDCT组,ULDCT组用于引导穿刺活检的平均CT扫描范围差异无统计学意义(P=0.520),而平均容积CT剂量指数、总剂量长度乘积及有效剂量均有所降低(P均＜0.05);且ULDCT组图像质量可满足穿刺活检需要。结论 三代双源CT超低剂量Sn 100 kVp能谱纯化成像用于引导经皮穿刺肺活检可在保证诊断成功率及安全性的同时降低辐射剂量。     

数字断层融合技术对肺内非钙化性结节灶检出能力评价

目的 探讨胸部数字断层融合摄影(DTS)与常规数字X线摄影(CDR)对肺部非钙化结节的检出能力。方法 对41例肺内非钙化结节患者行胸部DTS和CDR检查,以MDCT结果作为参照,分析胸部DTS和CDR对肺内不同直径的非钙化结节性病灶的显示结果。结果 41例患者经CT发现260个结节,胸部DTS发现238个,CDR发现74个。胸部DTS和CDR对直径3~5 mm、6~10 mm及>10 mm肺部非钙化结节的敏感度分别是86.36%(114/132)、95.60%(87/91)、100%(37/37)和10.61%(14/132)、37.36%(34/91)、70.27%(26/37)。对于直径≤10 mm的肺部非钙化结节,胸部DTS的检出能力明显优于CDR(P<0.01)。CDR对肺内非钙化结节性病灶总的敏感度为28.46%(74/260),胸部DTS则为91.54%(238/260),二者差异有统计学意义(P<0.01)。结论 对于检出肺部非钙化结节,胸部DTS比CDR更具优势,敏感度更高,特别对于直径≤10 mm的非钙化结节。     

CT 引导下亚甲蓝与Hookwire 联合术前定位在胸腔镜下孤立性肺小结节切除术中的应用

目的 探讨CT 引导下亚甲蓝与Hookwire 联合术前定位在胸腔镜下孤立性肺小结节(SPNs)切除术中的临床应用价值.方法 2008 年9 月至2010 年12 月共24 例患者,25 枚小结节,先行CT 引导下亚甲蓝与Hookwire 联合定位,后行全胸腔镜下(VATS) 肺楔形切除术.SPNs 直径(10.09 ±4.59)mm,距壁层胸膜(11.03 ±8.31)mm.统计定位时间、成功率、并发症;VATS 肺楔形切除手术时间、成功率、中转开胸率等.结果 联合定位时间(21.64 ±4.76)min,成功率100%,失败率为0.并发症发生率为33.3%:其中少量气胸5 例(20.8%),胸膜反应2 例(8.3%),轻度咯血1 例(4.2%),无血胸或血气胸.亚甲蓝定位失败2 例,Hookwire 脱落2 例.VATS 肺楔形切除手术时间(17.71 ±4.25)min,成功率100%,无中转开胸.SPNs 术后组织学诊断结果:14 枚为原发性肺癌,11 枚为良性病变.结论 SPNs 术前运用亚甲蓝与Hookwire 联合定位的方法 准确率高,并发症小,可提高VATS 肺楔形切除术的成功率,对于SPNs 的诊断及治疗具有很好的临床价值,值得临床推广运用.     

Efficacy of CT‐guided localization followed by video‐assisted thoracoscopic surgery in children with tiny pulmonary nodules

CT‐guided localization followed by video‐assisted thoracoscopic surgery was performed in three children with pulmonary nodules less than 5 mm in diameter. The patients' respective primary diagnoses were Wilms tumor, hepatoblastoma, and osteosarcoma of the femur. The pulmonary nodules were marked preoperatively by a percutaneously placed hook‐wire or dye under CT guidance. Although none of the nodules was grossly detected during the operation, they were correctly resected under the guidance of the hook‐wire wound or dye. A histological assessment revealed viable metastatic lesions in the case of hepatoblastoma, completely necrotic lesions in the case of Wilms tumor, and inflammatory nodules in the case of osteosarcoma. CT‐guided localization followed by video‐assisted thoracoscopic surgery appears to be a beneficial procedure in children with tiny pulmonary nodules.     

Thoracoscopic management of pulmonary nodules

Summary

More and more pulmonary nodules are currently approached via thoracoscopy. We have evaluated the results and the morbidity of a consecutive series of 120 patients operated on by a single surgeon. Patients and methods. One hundred and twenty-two nodules have been resected in 120 patients. The average size of these nodules was 16 mm (3–30 mm). A pre-operative localization technique was used in 61 patients (50%). The procedures were as follows: biopsy (6 cases), wedge-resection (110 cases). A video-assisted lobectomy was performed in 26 cases. Results. The mortality rate was 0.8% (one case of ARDS in the post-operative course of a video-assisted lobectomy). Intra-operative morbidity rate was 1.6% (2 cases of haemorrhage requiring a thoracotomy) and the postoperative morbidity rate was 5%. Six procedures were converted to thoracotomy (5%). The nodules were localized in all cases but 2 (1.6%). The mean post-operative stay was 4.6 days in the whole series and 3.2 days in the series of patients with a simple biopsy or wedge-resection. Comments. The morbidity rate of thoracoscopic resection of lung nodules is very low and decreases with the experience of the surgeon. Experience allows one not to use a localization technique in many cases, but the latter remains helpful in small-sized nodules. It allows for a safe, rapid and accurate procedure to be performed. The need for a mini-thoracot-omy is very rare. Mastering the techniques of radiological localization techniques, thoracoscopic biopsy and wedge resection as well as video-assisted lobectomies should make it possible for thoracoscopic resection of lung nodules to fulfil the criteria of a minimally invasive operation.     

Localization of pulmonary nodules before thoracoscopic surgery: Value of percutaneous staining with Indigocarmine Blue and CT-guided wire placement

Summary

The comparison of the CT-guided percutaneous wire localization and CT-guided percutaneous Indigocarmine Blue localization in preoperative detection of pulmonary nodules shows a great advantage of the former. Wire localization allows the detection and thoracoscopic resection even of deeply localized nodules. In the following article we present our experience with both methods and discuss critically the results.     

胸腔镜手术肺部小肿物定位方法的研究

目的:探讨解决肺部外周型小肿物胸腔镜手术时,小肿物难以定位的问题。方法:对本组15例肺部外周型小肿物在手术前1d下午,在CT室进行术前定位。于CT引导下行经皮肺穿刺术,在小肿物基底部注入TH-医用栓塞胶作为硬化示踪剂进行小肿物的定位。第2天行胸腔镜手术时,通过手指扪诊确定小肿物的位置,并行肺楔形切除送冰冻检查。结果:本组15例病人均成功行肺穿刺活检并注入硬化示踪剂,术中均在10min内顺利作出肿物准确定位。除2例病人穿刺后出现轻微气胸(肺压缩15%以下,无需进一步处理)外,无与本方法相关的并发症发生。结论:术前CT引导下肺小肿物穿刺注射TH-医用栓塞胶进行胸腔镜手术肺部小肿物定位的方法具有安全、方便、准确、易操作的优点,值得临床推广应用。     

CT引导穿刺定位胸腔镜下行肺小病灶切除术的护理

目的探讨CT引导穿刺定位胸腔镜下行肺小病灶切除术的护理经验。方法回顾性分析和总结26例在CT引导穿刺定位胸腔镜下行肺小病灶切除术的护理体会。结果 26例患者CT穿刺定位成功,胸腔镜下肺肿物切除手术顺利,定位时无气胸、血胸和肺出血等并发症发生。结论掌握正确的定位时机,加强体位管理,正确安全穿刺定位,做好手术配合对提高手术成功具有重要的意义。     

Precise localization of small pulmonary nodules using Pre-VATS with Xper-CT in combination with real-time fluoroscopy-guided coil: report of 15 patients

Purpose: This study aimed to evaluate the value of precise localization of nodules using pre-video-assisted thoracic surgery (VATS) Xper–CT in combination with real-time fluoroscopy-guided coil in the resection of pulmonary nodules using VATS.Materials and Methods: Precise localization of nodules using Xper-CT in combination with real-time fluoroscopy-guided coil and wedge resection using VATS were conducted on 15 patients with 17 small pulmonary nodules (diameter 0.5–1.5 cm) from April 2015 to January 2016. The value of localization was evaluated in terms of procedure time, type of coils, associated complications of localization, and VATS success rate.Results: The success rate of coil localization was found to be 100% in the primary stage (as shown by the CT scan), and the average procedure time was 30–45 min (35.6 ± 3.05 min). No deaths or major complications occurred. Minor complications included five incidents of pneumothorax (the morbidity was 29.4%, 5/17; no patient required chest tube drainage). The dislocation of coil was found in one patient. The results of pathological examination of 17 small pulmonary nodules revealed 11 primary lung cancers, 1 mesenchymal tumor, 3 nonspecific chronic inflammations, 1 hamartoma, and 1 tuberculosis. Two patients with primary lung cancer underwent lobectomy with mediastinal lymph node dissection.Conclusion: The preoperative precise localization of small pulmonary nodules using Xper-CT-guided coil is an effective and safe technique. It helps in the resection of nodules using VATS. It increases the rate of lung wedge resection with few complications and allows for proper diagnosis with a low thoracotomy conversion rate.     

手术治疗肺部孤立性结节病变106例

目的探讨开胸手术在肺部孤立性结节病变诊治中的应用价值。方法回顾性分析皖北煤电集团总医院2006年1月至2013年1月经常规开胸或胸腔镜下手术治疗106例肺部孤立性结节患者的临床资料,根据术后病理情况判断其临床开胸手术治疗价值。结果 106例肺部孤立性结节患者中男76例,女30例,年龄34～78岁,平均56岁,均经开胸手术治疗,原发性肺癌84例,结核球或结核性空洞7例,炎性假瘤3例,慢性肺脓肿1例,硬化性血管瘤2例,错构瘤5例,真菌病2例,孤立性纤维瘤2例。结论肺部孤立性结节是胸科较为常见的疾病,临床通过各种检查很难明确病理,但经过积极开胸手术治疗,术后病理确诊,恶性肿瘤占较大比例,所以临床上应采取积极开胸手术治疗,以免延误恶性疾病的诊治,达到早期治愈,提高患者的生存率。     

CT引导下Hookwire及亚甲蓝定位在肺部小结节胸腔镜术前应用

目的探讨CT引导下Hookwire与亚甲蓝定位在肺部小结节胸腔镜术前的应用价值。方法选取2011年10月-2013年5月在本院胸外科治疗的69例患者,分别在CT引导下对其75处肺小结节行Hookwire、亚甲蓝单独定位以及Hook—wire、亚甲蓝联合定位,并行全电视胸腔镜肺叶切除术（VATS）,其中Hookwire21例,22个病灶（A组）;亚甲蓝20例,21个病灶（B组）;Hookwire联合亚甲蓝28例,32个病灶（c组）。定位后行楔形切除或肺叶切除术,对照3组的定位成功率。结果A组定位成功18个病灶（81．8％）,脱落及未刺破胸膜4个病灶;B组定位成功18个病灶（85．7％）,3个病灶显示不清;C组定位成功32个病灶（100％）。A、B2组间差异无统计学意义（P〉0．05）;A、B组与C组间差异有统计学意义（P〈0．05）。结论肺部小结节胸腔镜术前CT引导下Hookwire、亚甲蓝单独定位的成功率稍低,Hookwire与亚甲蓝联合定位成功率高达100％,可提高VATS下切除孤立性肺结节的准确率。