摘要
目的研究CT引导下术前Hookwire定位肺部结节在临床应用的可行性和安全性。方法回顾性分析2015年6月至2020年4月瑞金医院胸外科北院病区102例因肺部结节拟行手术治疗患者的临床资料,其中男38例、女64例,年龄23~82(53.2±12.8)岁。结果102例患者的肺部结节均成功接受了CT引导下术前Hookwire定位,定位成功率100.0%;定位时间27.0(11~67)min;定位过程中需要调整角度的次数为6.9(3~14)次;定位针的进针深度为41.5(16.3~69.1)mm。有48例(47.1%)患者在定位后出现定位区域肺组织内的少量出血,53例(51.9%)患者在定位后出现少量气胸,16例(15.7%)患者在随后的手术中发现定位针完全从肺组织上脱落。1例患者因胸腔广泛致密粘连而中转开胸手术,其余101例患者均在胸腔镜下完成手术。术后病理提示:5例(4.9%)患者为原位腺癌、28例(27.5%)患者为微浸润性腺癌、36例(35.3%)患者为浸润性癌、32例(31.3%)患者为良性病变。没有患者出现术前定位相关的并发症及不良事件。结论术前CT引导下的Hookwire肺内结节定位技术安全、有效,能够满足临床绝大多数情况下胸外科医师的术中定位需求,且不劣于目前临床上所应用的其它术前定位方式。
Objective To study the feasibility and safety of CT-guided preoperative Hookwire localization of pulmonary nodules in clinical application.Methods Clinical data of 102 patients who were scheduled to undergo surgical treatment for pulmonary nodules from June 2015 to April 2020 in the North Ward of Thoracic Surgery Department of Ruijin Hospital were retrospectively analyzed.There were 38 males and 64 females,aged 23-82(53.2±12.8)years.Results All 102 patients with pulmonary nodules underwent CT-guided preoperative Hookwire localization successfully,with a localization success rate of 100.0%.The localization time was 27.0(11-67)min;the number of times to adjust the angle during the positioning process was 6.9(3-14);the needle depth of the positioning needle was 41.5(16.3-69.1)mm.A total of 48(47.1%)patients had a small amount of bleeding in the lung tissue in the positioning area after positioning;53(51.9%)patients had a small amount of pneumothorax after positioning;16(15.7%)patients were found that the positioning needle completely shedded from the lung tissue in the subsequent surgery.One patient was transferred to open thoracotomy because of extensive dense adhesion in the thorax,and the remaining 101 patients were operated on under thoracoscopy.Postoperative pathology showed that 5(4.9%)patients were adenocarcinoma in situ,28(27.5%)were microinvasive adenocarcinoma,36(35.3%)patients were invasive carcinoma and 32(31.3%)patients were benign lesions.No patients had complications or adverse events related to preoperative positioning.Conclusion Preoperative CT-guided localization of Hookwire intrapulmonary nodules is safe and effective,and can meet the intraoperative localization needs of thoracic surgeons in most clinical situations,and is not inferior to other preoperative localization methods currently used in clinics.
作者
陈学瑜
赵广垠
徐敬慈
陈小勇
朱良纲
李鹤成
CHEN Xueyu;ZHAO Guangyin;XU Jingci;CHEN Xiaoyong;ZHU Lianggang;LI Hecheng(Department of Thoracic Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,201801,P.R.China;Department of Radiology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,201801,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2022年第1期56-61,共6页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
上海市2020年“科技创新行动计划”优秀学术带头人(20XD1402300)
上海交通大学医学院高峰学科—临床医学“研究型医师”队伍建设实施方案(20172005)。
