摘要
目的观察对需行Ⅰ期肺癌切除术的患者使用胸腔镜手术(VATS)前CT引导下Hook-wire定位,及不同定位方式对切除术后复发率的影响。方法回顾性分析2013年6月至2016年8月治疗的117例孤立性磨玻璃结节(GGO)或孤立性肺结节(SPN)患者的临床资料。其中GGO者39例,SPN者78例;所有患者胸腔镜手术前均行CT引导下Hook-wire定位,使用Hook-wire穿刺针穿过病灶定位的共65例,穿刺针贴近病灶定位的共52例。根据手术结果,比较两种Hook-wire定位方式的定位情况、并发症及对Ⅰ期肺癌切除术后复发的影响。结果 117例患者定位用时(19±6)min;病灶直径为(16±4)mm,与脏层胸膜间的距离为(21±13)mm,其中GGO者39例,SPN者78例,均为孤立性肺部病灶。穿刺中共出现71例并发症(60. 68%),其中导丝脱落2例,气胸43例,轻微出血18例,轻微气胸并出血8例,穿刺中并发症较轻微,不影响VATS手术效果。所有患者均行VATS,10例胸腔粘连后转行开胸手术。术后病理结果,原发性肺癌73例,良性病变42例,转移性肿瘤2例。73例原发性肺癌中定位穿过病灶者39例(A组),贴近病灶定位者34例(B组),A组病灶与隔膜距离长于B组[(15±5)mm vs(13±3)mm,P=0. 046],A组术后复发率高于B组(20. 51%vs 2. 94%,P=0. 032),复发死亡率高于B组(15. 38%vs 0,P=0. 027)。结论胸腔镜手术前对Ⅰ期肺癌患者使用CT下引导Hook-wire定位发现贴近病灶的定位方式肺癌的术后复发率和死亡率更低,因此临床行VATS前应选择贴近病灶定位的方式。
Objective To explore the different localizations of CT-guided Hook-wire before video-assisted thoracoscopic surgery（VATS） and their effects on postoperative recurrence rate in patients undergoing one-stage operation for lung cancer. Methods A total of 117 patients with solitary ground-glass pulmonary nodules（GGO,n = 39） or solitary pulmonary nodules（SPN,n = 78） treated from June 2013 to August 2016 were retrospectively studied. Out of 117 patients undergoing CT-guided Hook-wire localization before VATS,65 received Hook-wire puncture needle location through lesion,and 52 received puncture needle location close to lesion. According to the surgical results,the localizations,complications and the influences on recurrence after one-stage operation by two Hook-wire localization methods were compared. Results In all cases,the localization time was（19 ± 6） min,the diameter of the lesions was（16 ± 4） mm,and the mean distance between the lesion and the visceral pleura was（21 ± 13） mm. All lesions were solitary pulmonary nodules. There were 71 cases（60. 68%） of complications,including 2 cases of wire shedding,43 cases of pneumothorax,18 cases of slight hemorrhage,8 cases of slight pneumothorax with hemorrhage. The complications during puncture were slight and did not affect the effect of VATS operation. After VATS,10 patients underwent thoracotomy because of thoracic adhesion.Postoperative pathological findings showed 73 cases of primary lung cancer,42 cases of benign lesions and 2 cases of metastatic tumors. In the patients with primary lung cancer,there were 39 cases with location through lesion（group A） and34 cases with location close to lesion（group B）. The distance between the lesion and the diaphragm in group A was longer than that in group B[（15 ± 5） mm vs（13 ± 3） mm,P = 0. 046]. The recurrence rate in group A was significantly higher than that in group B（20. 51% vs 2. 94%,P = 0. 032）,and the recurrence mortality was higher than that in group B（15. 38% vs0,P = 0.
作者
付斌彬
史家星
郑江敏
FU Bin-bin;SHI Jia-xing;ZHENG Jiang-min(Department of Thoracic surgery,General Hospital of Jizhong Energy Xingtai Mining Refco Group Ltd,Xingtai,Hebei 054000,China)
出处
《中国临床研究》
CAS
2018年第11期1512-1515,共4页
Chinese Journal of Clinical Research
关键词
肺癌
肺癌切除术
胸腔镜术前CT引导
Hook-wire定位
复发
孤立性磨玻璃结节
孤立性肺结节
Lung cancer
One-stage operation for lung cancer
CT guidance before thoracoseopie surgery
Hook-wire location
Recurrence
Solitary ground-glass pulmonary nodules
Solitary puhnonary nodules
