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。

Application of CT-guided percutaneous puncture wire claw localization in small pulmonary nodules before video-assisted thoracoscope surgery

Objective:Before video-assisted thoracoscope surgery (VATS) , CT-guided percutaneous wire mesh was used to locate the pulmonary nodules accurately and to analyze the accuracy and safety of surgically removing the focal lesions. Methods:The patients with small pulmonary nodules (36 cases) from March 2016 to March 2018 in Pu'er People's Hospital were collected, all cases were using the CT-guided percutaneous puncture wire claw localization in small pulmonary nodules, then VATS was performed to resect the lesion, and the puncture success rate, localization time and complications were analyzed. Results:The diameter of pulmonary nodules in 36 patients was (15±10) mm, the success rate of CT-guided puncture localization was 100% (36/36) , and the localization time was (17.0±2.6) min. A small amount of pneumothorax was observed in 4 patients after positioning, and pulmonary compression was <5%. Seven patients presented a small amount of bleeding in the localization area, with the bleeding volume <10 ml, without special treatment. All the patients had a slight tingling when the puncture site was foreign body sensation or breathing after local anesthesia failure. No severe pain, pneumothorax, hemoptysis, severe cough and air embolism occurred. There was no shedding or displacement of the probe during VATS operation. Conclusions:Using CT-guided percutaneous puncture wire claw positioning for lesions before the resection of small pulmonary nodules was safe, and it can improve the accuracy of lesion resection of VATS.