C臂CT在肺孤立性结节胸腔镜切除术术前定位中的应用

目的 评价肺内孤立性结节胸腔镜术前C臂CT引导下定位的可行性、安全性和临床价值.方法 19例共19个孤立性结节性病灶,术前皆行C臂CT引导下Hook-wire定位.根据手术结果,评价术前C臂CT引导下Hook-wire定位技术的成功率、并发症发生率、胸腔镜手术转为开胸手术的概率.结果 19例患者19个结节行胸腔镜切除术,术前C臂CT引导下Hook-wire定位成功率94.7％(18/19);无症状气胸发生率10.5％(2/19),均无需闭式引流治疗,无咯血、血胸等并发症.胸腔镜手术时间平均(15±8.5)min;无中转开胸病例;住院时间8～27d,平均14 d.肺内孤立性结节性病灶术后组织学诊断结果为支气管肺泡癌5例,腺癌3例,平滑肌肉瘤1例,非恶性结节8例.结论 胸腔镜术前C臂CT引导Hook-wire定位肺内孤立性结节病灶,快速、安全、有效,特别在直径≤10 mm的肺微小结节的定位中具有较高的临床价值.     

C臂CT在肺小结节胸腔镜切除术前定位中的应用

目的 探讨C臂CT在肺小结节胸腔镜术前定位中的应用价值.方法 回顾性分析2011年1月至2015年12月51例患者51个孤立性肺结节(SPN)于电视胸腔镜肺叶切除(VATS)术前行C臂CT引导下Hook-wire定位技术,并统计该技术的成功率、定位时间、并发症、VATS转开胸手术率,以及SPN平均大小,距脏层胸膜距离、病理学结果.结果 C臂CT引导下Hook-wire定位成功率100％,平均定位时间16 min,无症状气胸发生率7.8％,无症状出血率21.6％,1例(2.0％)发生脱落,SPN平均大小10.7 mm,距脏层平均距离25.3 mm,穿刺距离(皮肤至肺结节的距离)66.7 mm,恶性SPN占60.8％.结论 C臂CT引导下Hook-wire肺小结节定位准确、安全、快速,是一种高效的引导方式,具有临床应用价值.     

肺结节术前CT定位在胸腔镜中的应用价值

目的 探讨术前CT引导下定位针定位指导在胸腔镜手术中精准切除肺结节的临床价值。方法 选取经胸腔镜术前行CT定位的肺结节患者100例（实验组），另选取同期未行CT引导下定位而直接胸腔镜切除的患者100例（对照组），并统计穿刺成功率、病理结果、穿刺并发症等情况；对比胸腔镜手术时间、术后并发症等指标，分析可能影响并发症发生的相关危险因素。结果 实验组（130枚结节）定位成功率为100%，未发现定位针脱钩或移位。9例（9.0%）穿刺针道附近轻微出血；15例（15.0%）穿刺部位胸膜下出现少量气胸。结节与胸膜的距离、穿刺气胸的发生率差异有统计学意义（P<0.01）。实验组均无中转开胸手术，对照组中转开胸手术的约为6.0%，两组精准切除率、切除结节所需时间、术后住院时间等差异均有统计学意义（P<0.05），两组手术后并发症差异无统计学意义（P>0.05）。结论肺结节术前CT定位可以指导胸腔镜有效、精准、安全切除肺结节，缩短手术时间，降低并发症，因此对胸腔镜手术具有较高的增益意义。     

CT引导精准定位对胸腔镜切除肺小结节的临床价值

目的 探讨术前CT引导Hook-wire穿刺定位对胸腔镜切除肺小结节的临床价值。方法 回顾分析因肺小结节行胸腔镜手术患者临床资料,评价CT引导Hook-wire穿刺定位技术成功率,并与同期未定位直接手术者比较两组手术时间、术后住院时间等。结果 共212例纳入分析,穿刺定位组129例,未穿刺组83例;其中126例穿刺定位成功,成功率97. 67%。定位组中转开胸率4. 76%,肺楔形切除和肺叶切除时间分别为(20. 53±2. 50) min和(89. 01±10. 73) min,术后平均住院时间(4. 03±1. 57)天,均明显低于未定位组,差异具有统计学意义(P均0. 05)。结论 CT引导Hookwire穿刺定位,成功率高,有效降低中转开胸率、缩短手术时间及术后住院时间。     

CT引导下Hook-Wire针肺小结节定位术在胸腔镜肺结节切除术的临床应用

目的 探讨肺内小结节术前CT引导下Hook-Wire针定位术在胸腔镜切除术的临床应用价值。方法 选取我院胸腔镜术前行CT引导下hook-wire针定位119例患者共128枚结节,其中同步法多针定位6例(同侧肺4例、双侧肺2例)。记录定位成功率、定位操作时间、并发症、术后病理诊断结果。结果 119例128枚结节定位成功率96.9%,中位定位时间11.8 min,4枚定位针脱落(3.1%),其中1例定位针折断于胸壁内,极少量气胸5例(3.9%),病灶周围及针道出血11枚(8.6%)。术后病理炎性结节13枚,胸内淋巴结2枚,错构瘤1枚;非典型腺瘤样增生13枚,原位腺癌24枚,微浸润腺癌37枚,浸润性腺癌37枚,子宫内膜癌转移1枚。结论 胸腔镜术前行CT引导下Hook-wire针定位术定位准确,是一项安全、有效、并发症少的技术。     

CT引导下微创埋线技术在肺小结节胸腔镜术前穿刺定位中的应用

目的：探讨微创埋线技术在CT引导下肺小结节胸腔镜术前穿刺定位中的临床价值。方法：选择71例肺部小结节患者行局部CT扫描,体表定位、消毒、铺巾,采用德国宝雅Hook-wire穿刺定位系统进行穿刺,确定肺部病灶与穿刺针位置后,退出套针,金属线头端钩状结构展开,锚定肺部病灶或其邻近肺组织,将金属线留置于皮肤与肺组织之间。结果：68例穿刺定位成功,1例金属线钩住脏层胸膜,2例金属线脱落至胸膜腔,成功率95.8%。17例造成穿刺侧气胸,其中1例肺压缩约30%;9例病灶周围出血,其中咯血1例。31例刺中结节,37例定位线位于结节周围,距结节平均最短距离5.4 mm。结论：CT引导下穿刺埋置金属线成功率高、操作时间短、并发症少,可为胸腔镜手术提供精确定位。     

CT引导下Hookwire与亚甲蓝联合定位对胸腔镜下肺内多发结节切除术的指导价值

目的探讨CT引导下Hookwire与亚甲蓝联合定位对胸腔镜下肺内多发结节切除术的指导价值。方法对67例患者的147个肺小结节术前行CT引导下Hookwire与亚甲蓝联合定位后行胸腔镜下肺切除术。67例患者中男14例、女53例。年龄34~79岁,平均年龄(58.3±9.6)岁。结节直径为2.9~22.2mm,平均直径(9.1±4.4)mm;结节距胸膜平均距离为(8.4±8.6)mm。结果 147个肺结节CT引导下定位成功率100%,定位时间为(21.3±8.4)min。定位后并发症为少量气胸24例(35.8%),少量肺出血4例(6.0%)。术中1例(1.5%)Hookwire脱落。胸腔镜下结节切除术成功率100%。术后病理显示147个病灶中,腺癌79个、肺泡上皮不典型增生33个、鳞癌1个和良性病变34个。结论术前CT引导下联合Hookwire与亚甲蓝对肺多发结节定位具有可行性和有效性。     

CT引导下微弹簧圈定位在肺小结节胸腔镜术中的临床应用

目的 探讨电视胸腔镜手术(VATS)前CT引导下微弹簧圈定位肺小结节(SPN)对精准切除病灶的临床价值.方法 回顾性分析2014年6月至2016年5月,90例行VATS切除孤立性SPN患者的资料.其中45例患者术前行微弹簧圈定位(A组),45例患者未行术前定位(B组).统计分析两组VATS肺叶楔形切除时间、转开胸手术率、术后住院时间,以及微弹簧圈定位病灶的成功率、并发症等,评价术前微弹簧圈定位病灶的安全性及其对VATS术的增益价值.结果 A组VATS术成功率100％;SPN病灶定位成功率95.6％,术后出现气胸5例、肺表面出血6例、弹簧圈脱落2例等并发症.B组VATS手术成功率84.4％,中转开胸率15.6％.A组VATS手术时间(17.7±2.8) min、术后住院时间(6.2±1.7)d及中转开胸0例明显低于B组,差异具有统计学意义(P＜0.05).结论 CT引导下微弹簧圈定位,可辅助VATS快速、精确切除肺内小病灶,能有效降低中转开胸率、缩短VATS手术时间及术后住院时间.     

肺结节定位针对周围型浅表非实性肺小结节VATS术前CT引导下精准定位的临床应用

目的:探讨肺结节定位针在电视胸腔镜手术(VATS)下对周围型浅表非实性肺小结节术前CT引导下定位的有效性及安全性。方法:回顾性收集2020年4月-2021年3月60例患者共60个周围型浅表非实性肺小结节进行VATS术前CT引导下肺结节定位针定位的病例资料,统计肺结节定位针的定位成功率、定位时间、并发症。结果:60例周围型浅表非实性肺小结节患者VATS术前CT引导下采用肺结节定位针的定位成功率为100%,胸腔镜下周围型浅表非实性肺结节切除率为100%,结节定位时间平均为(14.15±3.12)分钟,气胸发生率为16.67%,肺出血发生率为13.33%。结论:CT引导下肺结节定位针对周围型浅表非实性肺小结节的定位成功率高、时间效率高、并发症轻微,可辅助VATS精准、快速、有效地对周围型浅表非实性肺小结节行肺楔形切除术,值得临床推广应用。     

孤立性肺结节术前MSCT图像后处理并钩丝定位

目的:评价MSCT图像后处理并钩丝定位技术对孤立性肺结节胸腔镜术前的临床应用价值。方法:55例肺结节患者,经MSCT图像后处理后植入Hook-wire定位钩丝,明确钩丝、肺结节、邻近血管、支气管、胸膜的关系;胸外科医师在胸腔镜术中先评估能否仅通过触摸法定位病灶;不能肯定者采用钩丝定位,最后经手术验证其准确性。2种定位方法的差异进行统计学分析。结果:MSCT图像后处理技术引导下穿刺定位全部成功(100%),平均操作时间(13.5±7.8)min。胸腔镜术中通过触摸法定位结节,符合率为78.2%(43/55);采用钩丝准确定位结节55例,符合率为100%(55/55);两者间差异具有统计学意义(χ2=13.47,P<0.01)。术后病理学检查均获得明确诊断。结论:胸腔镜切除肺结节术前行MSCT图像后处理并钩丝定位技术,操作安全,定位准确有效,能缩短胸腔镜手术时间,降低转为开胸手术的概率,具有较好的临床应用价值。     

孤立性肺结节胸腔镜术前三维CT引导下钩丝定位的价值

目的探讨孤立性肺结节术前三维CT引导下钩丝定位技术对胸腔镜手术的增益价值。方法收集行胸腔镜手术切除孤立性肺结节患者共92例,其中术前行三维CT引导下钩丝定位者37例,未行定位者55例。回顾性分析术前钩丝定位对胸腔镜转为开胸手术的几率、平均手术时间、平均住院时间的影响,并对其差异进行统计学分析。结果术前三维CT引导下钩丝定位成功率100．0％,定位操作时间平均（11．5±7．2）min,并发气胸及出血发生率为56．8％（21／37）。钩丝定位后胸腔镜转为开胸手术的几率为5．4％（2／37）,平均手术时间为（21．7±8．0）min,平均住院时间为（9．5±3．5）天。未定位直接行胸镜手术,转为开胸手术的几率为29．1％（16／55）、平均手术时间（45．9±10．4）min,平均住院时间为（14．1±4．5）天。分别进行X。检验和t检验,P〈0．05,差异有统计学意义。结论术前三维CT引导下钩丝定位技术安全、准确,降低了转为开胸手术的几率,缩短了胸腔镜的手术时间和住院时间,对于孤立性肺结节胸腔镜手术具有很好的增益价值。     

CT引导下经皮穿刺钢丝爪钩定位技术在肺部小结节电视胸腔镜手术前的应用

目的：于电视胸腔镜手术（VATS）前使用CT引导下经皮穿刺钢丝爪钩定位技术对肺部小结节进行精准定位,分析该技术对术中切除病灶的准确性与安全性的指导作用。 方法：选取2016年3月至2018年3月普洱市人民医院收治的孤立性肺部小结节患者36例,在CT引导下经皮穿刺钢丝爪钩定位针对肺部小结节进行穿刺定位,定位完成后再行VATS切除病灶,分析该方法的穿刺成功率、定位时间及并发症发生情况。 结果：36例患者的肺部小结节直径为（15±10）mm,CT引导下穿刺定位成功率100%（36/36）,定位时间为（17.0±2.6）min。4例患者在定位后行全肺扫描见少量气胸,肺压缩<5%;7例患者出现少量定位区域出血,出血量<10 ml,未行特殊处理;所有患者在局麻失效后均出现穿刺点异物感或呼吸时轻微刺痛;均未出现剧烈疼痛、血气胸、咯血、剧烈咳嗽和空气栓塞等严重并发症。定位完成后VATS术中探查定位针无脱落和移位。 结论：肺部小结节切除术前使用CT引导下经皮穿刺钢丝爪钩定位技术对病灶进行定位安全可靠,可有效提高肺小结节VATS术中病灶切除的准确性。     

Ultrasonographic localization of occult pulmonary nodules during video-assisted thoracic surgery

The aim of our study was to evaluate the role of ultrasonography in the localization of pulmonary nodules during video-assisted thoracic surgery (VATS). Ultrasonography was performed in 35 patients for the localization of pulmonary nodules during VATS. Indication for VATS was excisional biopsy of undetermined nodules in 22 patients, single or multiple metastasectomy in 12 patients and resection of primitive pulmonary cancer in 1 patient with reduced pulmonary reserve. A laparoscopic probe with flexible head and multi-frequency transducer (5–7.5 MHz) was used. Intraoperative ultrasonography localized 37 of 40 nodules preoperatively detected by CT and/or by positron emission tomography in 35 patients. Furthermore, ultrasonography localized two nodules not visualized at spiral CT. Eighteen nodules were not visible or palpable at thoracoscopic examination and were found by intraoperative sonography only. In 6 patients in whom thoracotomy was performed, manual palpation did not reveal more lesions than ultrasonography. In our experience, ultrasonography was very helpful when lesions were not visible or palpable during thoracoscopy, showing high sensitivity (92.5%) in finding pulmonary nodules. Since it is not possible to determine preoperatively whether a localization technique will be necessary during the operation or not, and ultrasonography is a non-invasive technique, we think that, at present, this technique can be considered as the first-instance localization technique during thoracoscopic resection of pulmonary nodules.     

CT-guided color marking of impalpable pulmonary nodules prior to video-assisted thoracoscopic surgery

ObjectivesTo investigate the utility and complications of computed tomography (CT)-guided color marking of impalpable pulmonary nodules for video-assisted thoracoscopic surgical resection.MethodsThis retrospective single institutional study has obtained Institutional Review Board approval. A total of 174 patients with 207 undiagnosed peripheral lesions of the lung were enrolled who had undergone preoperative computed tomography-guided color marking using colored collagen followed by video-assisted thoracoscopic surgery (VATS) from December 2015 to September 2018.ResultsAll nodules (mean 14.0 mm, range 3.0–30.0 mm) were successfully marked by computed tomography-guided color marking, and 96.0% cases (167/174) were localized by means of intraoperative fluoroscopy as clear spots. Minor pneumothorax with a median volume of 3.8 mL (range 0.2–119.0 mL) occurred in 12 patients (6.9%) who were completely asymptomatic and were not in serious condition. No patient required a chest tube. No major bleeding complication occurred, and no air emboli were seen. No intra- or post-operative mortality of VATS was observed.ConclusionsPreoperative CT-guided color marking of impalpable pulmonary nodules is a safe and effective procedure that allows for successful surgical resection.     

Modified Microcoil for Preoperative Localization of Solitary Pulmonary Nodules: A Prospective,Single-Arm,Multicenter Clinical Study

PurposeTo evaluate the efficacy and safety of placement of a modified microcoil for precise preoperative localization of solitary pulmonary nodules (SPNs) before video-assisted thoracoscopic surgery (VATS).Materials and MethodsThis prospective, single-arm, multicenter study included patients who underwent computed tomography (CT)-guided modified microcoil insertion prior to SPN resection by VATS between January 2018 and June 2018. The patient demographics, nodule characteristics, and histopathologic findings were recorded. The primary endpoints included efficacy and safety.ResultsA total of 96 patients (41 men and 55 women; mean age, 59.3 years ± 8.9) with 96 SPNs were eligible for enrolment in the study. The mean maximal transverse diameter of the nodules was 10.3 mm ± 5.2 (range, 8–20 mm). The mean time between CT-guided microcoil insertion and the start of the surgical procedure was 14.6 hours (range, 12–24 hours). The duration of the preoperative CT-guided microcoil localization procedure was 29 minutes ± 9 (range, 10–35 minutes), and the intraoperative fluoroscopy time was 0.7 minutes ± 0.7 (range, 0.5–3 minutes). The clinical success rate was 96.9% (93/96), and all nodules were successfully resected using VATS. One patient experienced asymptomatic pneumothorax, but there were no cases of pulmonary hemorrhage.ConclusionsSPN localization with the modified microcoil is feasible and safe. The modified microcoil can facilitate the thoracoscopic resection of SPNs.     

CT引导下Hook wire术前定位在15 mm及以下肺结节的应用及预后评估

目的探讨CT引导下Hook wire定位在15 mm以下肺结节行电视胸腔镜术前的有效性及安全性,并评估其预后。 方法收集2016年6月至2019年12月我院术前在CT引导下行Hook wire定位的138例患者,共140枚15 mm及以下的肺结节,随后行电视胸腔镜手术切除。回顾性分析定位时间和技术成功率,单因素分析及多因素Logistic回归分析定位相关并发症的影响因素。观察术后随访期间有无复发或转移。 结果CT引导下Hook wire定位技术成功率100%,术中发现脱钩3例。140枚结节平均大小（7.8±2.7） mm,结节与胸膜距离（8.8±7.5） mm。平均定位时间（13.6±3.9）min。定位后无症状气胸23例（16.4%）,肺实质出血（0级22例,1级61例,2级57例）,咯血1例（0.7%）。单因素分析发现体位、经肺穿刺次数、定位时间是气胸发生的风险因素,进一步Logistic回归分析表明仰卧位、经肺穿刺1次成功是气胸发生的保护因素。50例患者术后进行CT随访,随访时间（1～32）个月,中位随访时间5个月,未见复发或转移。 结论对于15 mm及以下的肺结节,CT引导下Hook wire是一种有效、便捷、安全的电视胸腔镜术前定位方法,仰卧位及减少经肺穿刺次数有利于避免气胸的发生。患者术后短期预后好。     

CT-Guided Microcoil Localization of Small Peripheral Pulmonary Nodules to Direct Video-Assisted Thoracoscopic Resection without the Aid of Intraoperative Fluoroscopy

ObjectiveTo evaluate the feasibility, safety, and effectiveness of CT-guided microcoil localization of solitary pulmonary nodules (SPNs) for guiding video-assisted thoracoscopic surgery (VATS).Materials and MethodsBetween June 2016 and October 2019, 454 consecutive patients with 501 SPNs who received CT-guided microcoil localization before VATS in our institution were enrolled. The diameter of the nodules was 0.93 ± 0.49 cm, and the shortest distance from the nodules to the pleura was 1.41 ± 0.95 cm. The distal end of the microcoil was placed less than 1 cm away from the nodule, and the proximal end was placed outside the visceral pleura. VATS was performed under the guidance of implanted microcoils without the aid of intraoperative fluoroscopy.ResultsAll 501 nodules were marked with microcoils. The time required for microcoil localization was 12.8 ± 5.2 minutes. Microcoil localization-related complications occurred in 179 cases (39.4%). None of the complications required treatment. A total of 463 nodules were successfully resected under the guidance of implanted microcoils. VATS revealed 38 patients with dislocated microcoils, of which 28 underwent wedge resection (21 cases under the guidance of the bleeding points of pleural puncture, 7 cases through palpation), 5 underwent direct lobectomy, and the remaining 5 underwent a conversion to thoracotomy. In 4 cases, a portion of the microcoil remained in the lung parenchyma.ConclusionCT-guided microcoil localization of SPNs is safe and reliable. Marking the nodule and pleura simultaneously with microcoils can effectively guide the resection of SPNs using VATS without the aid of intraoperative fluoroscopy.     

拟诊肺癌患者肺额外结节切除术前介入定位

目的 探讨CT引导微弹簧圈定位电视辅助胸腔镜手术(VATS)切除拟诊肺癌患者肺部额外小结节病灶的价值.方法 对11例拟诊肺癌患者的肺部额外小结节行CT引导下微弹簧圈术前定位.微弹簧圈前端位于靶病灶旁,尾部留置于胸膜表面.之后24 h内行VATS切除,进行肺部主要病灶与额外靶病灶的手术及病理综合评估,选择合适的手术方式进行切除.结果 VATS成功切除术前定位的11个肺小结节病灶(直径4~15 mm),9个病灶的定位用微弹簧圈留尾于肺脏层胸膜表面.定位操作均无严重并发症出现.手术另外切除包含11个肺部主要病灶的16个肺内病灶,获得肺内病灶全面的手术及病理评估结果.结论 微弹簧圈术前定位方法为VATS完成切除并评估拟诊肺癌患者肺内多发病灶提供新的思路.     

Purposeful Creation of a Pneumothorax and Chest Tube Placement to Facilitate CT-Guided Coil Localization of Lung Nodules before Video-Assisted Thoracoscopic Surgical Wedge Resection

PurposeTo evaluate the feasibility and efficacy of pneumothorax creation and chest tube insertion before computed tomography (CT)–guided coil localization of small peripheral lung nodules for video-assisted thoracoscopic surgical (VATS) wedge resection.Materials and MethodsFrom May 2011 to October 2013, 21 consecutive patients (seven men; mean age, 62 y; range, 42–76 y) scheduled for VATS wedge resection required CT-guided coil localization for small, likely nonpalpable peripheral lung lesions at a single institution. Outcomes were evaluated retrospectively for technical success and complications.ResultsThere were 12 nodules and nine ground-glass opacities. Mean lesion distance from the pleural surface was 15 mm (range, 5–35 mm), and average size was 13 mm (range, 7–30 mm). A pneumothorax was successfully created in all patients with a Veress needle, and a chest tube was inserted. All target lesions were marked successfully, leaving one end of the coil within/beyond the lesion and the other end of the coil in the pleural space. The inserted chest tube was used to insufflate air to widen the pleural space during coil positioning and to aspirate any residual air before transfer of the patient to the operating room holding area. Intraparenchymal hemorrhages smaller than 7 cm in diameter developed in two patients during coil placement. All lesions were successfully resected with VATS. Histologic examinaiton revealed 13 primary adenocarcinomas, four metastases, and four benign lesions.ConclusionsPneumothorax creation and chest tube placement before CT-guided coil localization of peripheral lung nodules for VATS wedge resection facilitates the deployment of the peripheral end of the coil in the pleural space and provides effective management of procedure-related pneumothorax until surgery.