摘要
目的探讨术前低剂量MSCT引导下带钩钢丝针定位在电视胸腔镜肺结节手术中的临床疗效。方法回顾性分析2018年1～8月我院胸外科术前低剂量MSCT引导定位下经电视胸腔镜行肺结节手术治疗的33例患者的临床资料。所有患者均在手术前1 h行低剂量MSCT下穿刺定位,再行电视胸腔镜下肺结节部位楔形切除术。切除标本送快速冰冻切片病理分析,依据病理结果再决定下一步手术方案。分析术前结节大小、定位时间等相关指标与并发症、定位成功率等的关系。应用单因素及多因素回归分析探讨影响并发症及定位成功率的相关因素。结果所有患者均顺利完成手术,结节大小5～15 mm,距胸膜下距离5～30 mm,进针深度10～30 mm,定位成功率94%。气胸、肺内血肿、定位针脱出等定位穿刺并发症33%。术后病理:浸润性腺癌5例,微浸润性腺癌6例,原位腺癌16例,不典型腺瘤样增生3例,良性结节3例。单因素分析显示,仅进针角度是并发症发生的显著影响因素(P <0. 05)。多因素Logistic逐步回归模型分析显示穿刺时间(OR=1. 356 0,P=0. 042 0)、进针角度(OR=0. 959 6,P=0. 021 6)是并发症发生的独立危险因素。结论术前低剂量MSCT引导下带钩钢针定位在电视胸腔镜肺部结节手术中易于操作,安全性高,并发症少,能够为电视胸腔镜手术降低难度、缩短手术时间。
Objective To investigate the clinical effect of preoperative low dose MSCT guided positioning needle localization in videoassisted thoracoscopic surgery for pulmonary nodules. Methods The clinical data of 33 patients who underwent low dose MSCT guided videoassisted thoracoscopic surgery in our hospital were collected from January 2018 to August 2018. All the patients underwent low-dose MSCT puncture localization 1 hour before surgery,followed by video-assisted thoracoscopic wedge resection of pulmonary nodules. The resected specimen was sent to fast frozen section for pathological analysis,and then the next operation plan was determined according to the pathological results. Analyzed the relationship between preoperative nodule size,positioning time and complications as well as the positioning success rate. Univariate and multivariate regression analysis was used to investigate the factors affecting the complications and the success rate of localization. Results All the patients successfully completed the operation. The size of nodules was 5 to 15 mm,the distance from the pleura was 5 to 30 mm,the depth of needle insertion was 10 to 30 mm,and the success rate of localization was 94%. Complications such as pneumothorax,intrapulmonary hematoma and removal of localization needle were 33%. According to the result of postoperative pathologies,there were 5 cases of invasive adenocarcinoma,6 cases of micro-invasive adenocarcinoma,16 cases of adenocarcinoma in situ,3 cases of atypical adenomatous hyperplasia,and 3 cases of benign nodules. Univariate analysis showed that only the insertion angle was a significant factor( P < 0. 05). Multivariate logistic stepwise regression model analysis showed that puncture time( OR = 1. 356 0,P = 0. 042 0) and needle angle( OR = 0. 959 6,P = 0. 021 6) were independent risk factors for complications. Conclusion In the operation of video-assisted thoracoscopic surgery( VATS),preoperative low dose MSCT guided positioning needle localization has the advantages of easy to operate,high safet
作者
李俊生
李旭
王强
林善安
郭英伟
徐晓文
章雪林
吴海鸰
王晓军
LI Jun-sheng;LI Xu;WANG Qiang;LIN Shan-an;GUO Ying-wei;XU Xiao-wen;ZHANG Xue-lin;WU Hai-ling;WANG Xiao-jun(Department of Cardiothoracic Surgery,Taizhou Central Hospital(Affiliated Hospital of Taizhou University),Taizhou Zhejiang 318000,China;Department of Radiology,Taizhou Central Hospital(Affiliated Hospital of Taizhou University),Taizhou Zhejiang 318000,China)
出处
《局解手术学杂志》
2019年第3期238-242,共5页
Journal of Regional Anatomy and Operative Surgery
基金
吉林省重点科技攻关项目(20170204054SF)
关键词
低剂量MSCT
带钩钢针
电视胸腔镜
肺结节
定位
low dose MSCT
positioning needle
video-assisted thoracoscopic
pulmonary nodules
localization
