肺部周边小结节术前定位在胸腔镜外科的应用

目的：明确胸腔镜切除肺周边小结节术前Hook-wire标记的价值及意义。方法：我院于2000-2010年胸腔镜下或辅助小切口进行肺周边小结节切除共30例,其中在螺旋CT指引定位下穿刺留置Hook-wire16例,其定位的肺小结节直径〈10mm,或距壁层胸膜〉10mm。结果：16例术前CT引导下Hook-wire定位,成功率100%,并发症12.5%,转化为开胸者6.25%,中位住院时间5天。术后组织学结果：原发性肺腺癌9例,鳞癌2例,小细胞肺癌1例,转移瘤3例,炎性假瘤1例。结论：术前肺周边小结节Hook-wire定位对于VATS术中定位具有指导作用。

Application for Preoperative Localization of Small Peripheral Pulmonary Nodules in Thoracoscopic Surgery

Objective：To determine indications for preoperative Hook-wire marking in thoracoscopic resection of small peripheral pulmonary nodules（SPPNs）.Methods：A total of 30 patients underwent thoracoscopic pulmonary resection in our hospital from 2000 to 2010.Of 16 patients with SPPNs were marked preoperatively by means of percutaneous placement of a Hook-wire under computed tomographic guidance.The SPPNs Hook-wire-marked were smaller than 10mm in diameter or were located more than 10mm distance beneath the pleural surface.Results：16 patients underwent preoperative CT-guided hook-wire localization and VATS approach successfully.The complications following preoperative Hook-wire marking localization occurred in 2 patients.The average hospital stay was 5 days（ranged2-25 days）.Histological assessment revealed adenocarcinoma in 9 cases,squamas cell lung cancer in 2 cases,metastasis in 3 cases,small cell lung cancer and inflammatory disease in 1respectively.Conversion of thoracotomy was necessary in 1 case due to the severe pleural adhesion.Conclusion ： Preoperative Hook-wire marking of SPPNs is helpful to localize the pulmonary lesion during thoracoscopic resection.