肺小结节胸腔镜术前CT引导硬化剂定位的临床比较研究

目的探讨肺小结节胸腔镜术前CT引导硬化剂定位的临床效果比较。方法选取2015年11月~2017年1月在我院胸外科治疗的68例拟行胸腔镜肺叶切除术(VATS)患者,根据随机数字表法随机分为试验组和对照组,各34例(35个病灶);在CT引导下,对照组对肺小结节予以Hookwire单独定位,试验组对小结节进行硬化剂定位,定位后根据情况予以切除或者行肺段、肺叶切除术,对比两组患者的的定位成功率及定位时间。结果 CT扫描结果显示,70个肺小结节病灶中左肺31个(44.29%),右肺39个(55.71%)。56例患者由结节切除后送冰冻病理证实为恶性且进行肺叶切除以及纵隔内淋巴结清扫术,14例患者由于存在结节或胸壁粘连严重,转至开胸手术。各病灶病理检查结果提示浸润性腺癌占34.29%,微浸润腺癌占10.00%,原位腺癌占17.14%,不典型腺瘤样增生占15.71%,慢性炎性病变10.00%,肺内淋巴结7.14%,肉芽肿5.71%。试验组定位成功率97.14%,高于对照组的80.00%(P0.05)。试验组定位时间(19.97±3.21)min,低于对照组的(34.37±4.53)min(P0.05)。结论肺部小结节胸腔镜术前予以CT引导硬化剂定位能够显著提高胸腔镜肺叶切除术下切除孤立性肺结节的准确率。

A clinical comparative study of CT-guided hardening agent localization before the thoracoscopic surgery of small pulmonary nodules

Objective To investigate the clinical effect of CT-guided hardening agent localization before the thoracoscopic surgery of small pulmonary nodules.Methods 68 patients scheduled for video-assisted thoracic surgery(VATS) who were treated in the department of thoracic surgery of our hospital were chosen and randomly divided into test group and control group according to the random number subscale method,with 34 cases in each group(35 lesions).The control group was given Hookwire localization alone for small pulmonary nodules under CT guidance.And the test group was given hardening agent localization for the small pulmonary nodules,and after localization,the patients in the test group were treated with resection of the lungs or lobectomy according to the circumstances.The localization success rate and localization time between the two groups of patients were compared.Results CT scan results showed that there were 31 cases in left lung and 39 cases in right lung(55.71%)of the 70 small pulmonary nodules.56 patients were confirmed to be malignant by frozen pathology of the nodules resected of nodules and underwent lobectomy and mediastinal lymphadenectomy.And 14 of them were switched to thoracotomy due to the presence of nodules or serious chest wall adhesions.Pathological examination of the lesions suggested that invasive adenocarcinoma accounted for 34.29%,micro invasive adenocarcinoma for 10.00%,in situ adenocarcinoma for 17.14%,atypical adenomatoid proliferation for 15.71%, chronic inflammatory lesions for 10.00%,pulmonary lymph nodes for 7.14%and granuloma for 5.71%.The success rate of localization was 97.14%in the test group,higher than that of the control group(80.00%,P<0.05).The localization time(19.97±3.21)min in the test group was lower than that in the control group(34.37±4.53)min(P<0.05).Conclusion CT-guided hardening agent localization before the thoracoscopic surgery of small pulmonary nodules can significantly improve the accuracy of solitary pulmonary nodules resection under thoracoscopic lobectomy.