孤立性肺结节胸腔镜术前三维CT引导下钩丝定位的价值

目的探讨孤立性肺结节术前三维CT引导下钩丝定位技术对胸腔镜手术的增益价值。方法收集行胸腔镜手术切除孤立性肺结节患者共92例，其中术前行三维CT引导下钩丝定位者37例，未行定位者55例。回顾性分析术前钩丝定位对胸腔镜转为开胸手术的几率、平均手术时间、平均住院时间的影响，并对其差异进行统计学分析。结果术前三维CT引导下钩丝定位成功率100．0％，定位操作时间平均（11．5±7．2）min，并发气胸及出血发生率为56．8％（21／37）。钩丝定位后胸腔镜转为开胸手术的几率为5．4％（2／37），平均手术时间为（21．7±8．0）min，平均住院时间为（9．5±3．5）天。未定位直接行胸镜手术，转为开胸手术的几率为29．1％（16／55）、平均手术时间（45．9±10．4）min，平均住院时间为（14．1±4．5）天。分别进行X。检验和t检验，P〈0．05，差异有统计学意义。结论术前三维CT引导下钩丝定位技术安全、准确，降低了转为开胸手术的几率，缩短了胸腔镜的手术时间和住院时间，对于孤立性肺结节胸腔镜手术具有很好的增益价值。

The incremental value of three-dimensional computed tomography-guided localization with Hook-wire for solitary pulmonary nodule before thoracoscopic surgery

Objective To evaluate the incremental value of three-dimensional computed tomography-guided localization with Hook-wire for solitarypulmonary nodule （SPN） before video-assisted thoracoscopic surgery （VATS）. Methods From Jan 2003 to Dec 2011, 92 patients underwent thoracoscopic pulmonary resection, of which 37 patients with SPN were preoperatively localized by CT-guided Hook- wire, other 55 patients without being localized using CT-guided Hook- wire. The onversion rate of open thoracotomy, average duration of operation and average hospitalization time were retro- spectively compared between two groups, t -test and X2 test were used. Results Preoperative CT-guided Hook-wire locali- zation was successful in all patients （100.0%）. The average localization time was （11.5±7.2） min. The occurrence rate of pneumothorax and hemothorax was 56.8% （21/37）. In two group with and without Hook-wire localized, the conversion rate of open oracotomy, average duration of operation and average hospitalization time were 5.4 % （2/37）, （21.7 ±8. 0） min, （9.5±3.5） d and 29.1%（16/55）, （45.9±10.4） min, （14.1±4.5） d, respectively. There were statistically signif- icant different between with and without Hook-wire localized groups （ P 〈0.05）. Conclusion Preoperative CT-guided Hook-wire localization is suitable, safe and effective for VATS resection of SPN. It is related to a low alteration thoracoto- my rate, short operation time and hospitalization time, and it has incremental value for the VATS resection of SPN.