CT引导下注射医用胶在肺部小结节胸腔镜术前定位中的应用

目的 探讨CT引导下注射医用胶在肺部磨玻璃影和小结节胸腔镜手术前定位中的临床应用价值。方法 自2013年12月至2014年11月期间收治单纯肺部磨玻璃影(pure ground-glass opacity,pGGO)患者10例和肺孤立性小结节(solitary pulmonary nodule,SPN)患者15例,术前在CT引导下向病灶旁注射医用胶后行胸腔镜肺楔形切除或肺段切除术。结果 25例病灶均定位成功,平均操作时间为(17.1±6.1) min ,穿刺后出现气胸1例(4%),胸痛5例(20%),刺激性咳嗽6例(24%),手术pGGO组10例患者,平均手术时间(23.1± 5.6)min,病理结果肺腺癌7例(70%),非典型腺瘤样增生2例(20%),子宫内膜异位1例(10%),SPN组15例患者,平均手术时间(20.4± 5.9)min,病理结果肺腺癌9例(60%),转移癌1例(6.7%)良性结节5例(33.3%),全部手术无中转开胸及重大合并症。结论 CT引导下注射医用胶是一种安全、简便并且准确的定位方法,对胸腔镜肺部磨玻璃影和小结节的术中定位有很好的临床价值。

Application of CT-guided localization with medical glue injection in treatment of ground-glass opacity and pulmonary nodules with video-assisted thoracoscope surgery

Objective To evaluate the clinical value of CT-guided localization with medical glue injection in treatment of ground-glass opacity(GGO) and pulmonary nodules with video-assisted thoracoscope surgery(VATS). Methods From December 2013 to November 2014, 10 patients with pure ground-glass opacity(pGGO) and 15 patients with solitary pulmonary nodule(SPN) underwent wedge resection or segmentectomy by VATS. All the patients were injected with medical glue by CT-guided localization before operation. Results CT-guided localization with medical glue was successful in all patients(100%). The time of puncturing was (17.1±6.1)min. There were 1 case of pneumothorax(4%), 5 cases of chest pain(20%) and 6 cases of cough(24%) respectively. The time of operation was (23.1±5.6)min in 10 patients with pGGO, 7 cases with adenocarcinoma were pathologically confirmed, 2 cases of atypical adenomatous hyperplasia, and 1 cases of adenomyosis. The time of operation was (20.4±5.9)min in 15 patients with SPN, 9 cases of adenocarcinoma, 1 case of carcinoma metastaticum, and 5 cases of nonmalignant disease. No conversion to thoracotomy was necessary in any patients and no VATS postoperative major complications occurred. Conclusion There are many advantages of the application, such as safety, simple and accuracy. It is a viable technique for pGGO and SPN localization.