256层CT多平面重建技术对肺结节胸腔镜术前定位的指导价值

目的探讨256层CT多平面重建（MPR）技术提高肺结节胸腔镜术前定位成功率的效果。方法对30例肺结节患者行胸腔镜（VATS）肺楔形切除术，术前行低剂量CT引导下Hook-wire定位或Hook-wire联合亚甲蓝定位肺结节。在穿刺定位过程中对容积数据进行轴位、矢状位及冠状位图像重建，指导穿刺定位的进针轨迹。结果MPR技术指导VATS术前肺结节定位成功率100％，定位操作时间11-28min，平均18．4min。8例（26．7％）发生并发症，其中无症状气胸5例，无症状出血2例，无症状气胸和出血1例。2例术中金属钩脱落，胸腔镜下观察肺组织表面血肿或亚甲蓝染色，据此定位后成功手术切除。结论MPR导向直观显示穿刺定位路径，对肺结节VATS术前低剂量CT引导下Hook-wire定位有一定的指导价值。

Directive value of 256-slice CT multi-planar reconstruction technology for preoperative localization of video-assisted thoracoscopic pulmonary nodules resection

Objective To evaluate directive value of 256-slice CT multi-planar reconstruction （MPR） technology in preoperative video-assisted thoracoscopic surgery （VATS） for pulmonary nodules localization. Methods Thirty pati- ents with pulmonary nodules were treated with video-assisted thoracoscopic wedge resection. All patients received low- dose CT-guided localization with Hook-wire or Hook-wire combined with methylene blue. Volume data in puncture loc- alization axial, sagittal, and coronal image reconstruction were processed to guide puncture localization the needle trajec- tory. Results The success rate of pulmonary nodules localization guided by MPR technology was 100%. Procedure was completed in a mean time of 18.4 minutes （ranged from 11 to 28 minutes）. Eight patients developed postoperative complications, including five cases ofasymptomatic pneumothorax, two case ofasymptomatic bleeding, and one case of asymptomatic pneumothorax complicated with hemorrhage. Metal hook shedding occurred in two cases, and hematoma or staining with methylene blue which localized the lesion was observed, and then the resection was completed success- fully.Conclusions 256-slice CT multi-MPR can visually display the puncture location path, and the technology is help- ful for preoperative localization of video-assisted thoracoscopic pulmonary nodules resection.