肺内小结节的术前定位在胸腔镜外科手术中的应用价值

目的：探讨肺内小结节电视胸腔镜手术（video-assisted thoracoscopic surgery，VATS）术前采用CT引导下Hook-wire或亚甲蓝定位的临床价值。方法90例肺内小结节手术患者共94枚小结节，VATS术前均行CT引导下Hook-wire或亚甲蓝定位。评价术前定位的成功率、并发症、转开胸手术发生率、术后病理类型等。结果 Hook-wire钢丝定位72枚，成功率91.7%；亚甲蓝注射定位22枚，成功率86.4%。穿刺后发现并发少量血胸6例（6.4%），并发少量气胸8例（8.5%）。转开胸手术4例，占4.4%。术后经病理证实良性病灶36枚，占38.3%，恶性病灶58枚，占61.7%。结论术前CT引导下Hook-wire或亚甲蓝定位肺内小结节方法准确率高，并发症少，能提高VATS手术成功率，对肺内小结节的胸腔镜手术诊治具有很好的临床价值。

Value of preoperative localization of small pulmonary nodules in thoracoscopic surgery

Objective To analyze the clinical value of preoperative CT- guided Hook-wire puncturing or methylxanthine chloride staining in treatment of the small pulmonary nodules with video assistant thoracic surgery （VATS）. Methods A retrospective review of 90 patients with 94 small pulmonary nodules undergoing VATS,using pre-operative CT-guided puncturing or methylxanthine chloride staining was performed. The puncturing achievement ratio, the complications and the conversion to thoracotomy ratio of preoperative localization were summarized and analyzed. Results The puncturing achievement ratio was 91.7%by Hook-wire puncturing and 86.4%by methylxanthine chloride staining,respectively. The complications included pneumothorax,hemothorax,puncturing failure,and Hookwire needle loss. In pathological results,benign lesions and malignant lesions accounted for 38.3% and 61.7%,respectively. Conclusions The application of preoperative CT-guided Hook-wire puncturing or methylxanthine chloride staining in treatment of the small pulmonary nodules with video assistant thoracic surgery increases the achievement ratio of VATS with few complications,and may be widely used in clinical diagnosis and treatment of small pulmonary nodules with VATS.