定位技术在电视胸腔镜诊治孤立性肺小结节中的应用

背景与目的电视胸腔镜已广泛应用于孤立性肺小结节(solitary pulmonary nodule,SPN)的诊治,但经常遇到术中无法准确定位病灶的情况。本研究探讨电视胸腔镜手术(video-assistant thoracoscopic surgery,VATS)在诊治孤立性肺小结节过程中的定位技术的临床应用价值。方法对孤立性肺小结节患者,术前先行三维CT定位,如SPN≤1.5 cm,或深达肺胸膜下2.0 cm,予行Hook-wire定位,术中先用器械间接触诊法,如失败改行电视胸腔镜辅助小切口(video-assisted minithoracotomy,VAMS),用手指直接触诊法定位,术中定位成功后,以直线切割缝合器行SPN楔形切除术,术后快速冰冻病理检查以决定下一步治疗方案。结果本组23例完成了胸腔镜SPN的切除,其中完全胸腔镜手术10例,VAMS 13例。结论电视胸腔镜SPN切除术术前术中的精确定位具有临床应用价值。

Application of the Localization Technique in Video-assisted Thoracoscopy for the Diagnosis and Treatment of Solitary Pulmonary Nodule

Background and objective Video-assisted thoracoscopy is widely used in diagnosis and treatment of solitary pulmonary nodule(SPN).However,localization of the nodule during surgery is occasionally difficult.The purpose of the current research is to evaluate the localization technique during diagnosis and treatment of SPN with video-assistant thoracoscopic surgery(VATS).Methods Three-dimensional computed tomography is performed for SPN localization.If SPN is less than 1.5 cm or more than 2.0 cm beneath the pleura,Hook-wire localization technique is used.During operation, initial action is palpation with equipment.If this method fails,video-assisted minithoracotomy(VAMS) and direct finger use are applied for localization.Upon successful localization,a linear cutter is used for wedge resectioning.Fast frozen pathology is employed to make the decision for the next procedure.Results SPNs are resected for 23 cases.Among them,10 cases are performed with VATS and 13 cases are conducted with VAMS.Conclusion The accurate localization of SPN before and during surgery is very significant for the resectioning of SPN by VATS.