胸腔镜手术肺部小肿物定位方法的研究

目的:探讨解决肺部外周型小肿物胸腔镜手术时,小肿物难以定位的问题。方法:对本组15例肺部外周型小肿物在手术前1d下午,在CT室进行术前定位。于CT引导下行经皮肺穿刺术,在小肿物基底部注入TH-医用栓塞胶作为硬化示踪剂进行小肿物的定位。第2天行胸腔镜手术时,通过手指扪诊确定小肿物的位置,并行肺楔形切除送冰冻检查。结果:本组15例病人均成功行肺穿刺活检并注入硬化示踪剂,术中均在10min内顺利作出肿物准确定位。除2例病人穿刺后出现轻微气胸(肺压缩15%以下,无需进一步处理)外,无与本方法相关的并发症发生。结论:术前CT引导下肺小肿物穿刺注射TH-医用栓塞胶进行胸腔镜手术肺部小肿物定位的方法具有安全、方便、准确、易操作的优点,值得临床推广应用。

A novel technique for preoperative localization of small peripheral pulmonary nodules preceding thoracoscopic surgery

Objective To explore a better procedure to localize small peripheral pulmonary nodules preceding thoracoscopic resection. Methods 15 patients were injected with TH- medical obturation glue into the base of the nodule within their lungs following percutaneous pulmonary acupuncture guided by computed tomography (CT) on one day afternoon. The location of the nodule was accurately confirmed. A thoracoscopic wedge resection of the TH- labeled areas was performed and a frozen biopsy was carried out during the operation in the next morning. Results Pulmonary acupuncture in combination with TH injection was successfully finished within 10 minites. No complications occured except a small pneumothorax (less than 15% ) in two cases in which no advanced management was necessary. Conclusion CT guided percutaneous pulmonary acupuncture plus TH injection preceding thoracoscopic resection is a fast, safe, effective and easy procedure for localization of pulmonary nodules.