Chella A, Lucchi M, Ambrogi M C, Menconi G, Melfi F M, Gonfiotti A, Boni G, Angeletti C A
Cardiac and Thoracic Department, Division of Thoracic Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
Eur J Cardiothorac Surg. 2000 Jul;18(1):17-21. doi: 10.1016/s1010-7940(00)00411-5.
Video-assisted thoracic surgery (VATS) is an interesting and emerging procedure for diagnosis and treatment of peripheral pulmonary nodules. However, thoracoscopy has limits in the detection of small nodules, below the pleural surface, deep in the lung parenchyma, which cannot be seen as much as palpated. Methods to localize such lesions, including the methylene blue injection or the introduction of a hooked-wire under the radiological vision, have some advantages but a lot of limitations. We are developing a new technique for the detection of pulmonary nodules smaller than 2 cm, deep in the lung parenchyma.
The technique consisted of a intra-lesional injection of 0.3 ml of solution of 99m Tc-labelled human serum albumin microspheres (5-10 MBq) under the CT-scan guide, 2 h before surgery. During thoracoscopy a 11 mm diameter-collimated probe connected to a gamma ray detector (Scinti Probe MR 100 - Pol. hi.tech., Aquila - Italy), is introduced by a 11.5 mm trocar and the pleural surface of the suspected area was scanned. A hot-spot indicated the presence of the injected nodule and as a consequence, the area to be resected.
from June 1997 to June 1999 we treated 39 patients with small pulmonary nodules. The patients were 27 men and 12 women with a mean age of 60.8 years (range: 13-80). In 19 cases the anamnesis was positive for synchronous or metachronous malignant neoplasm. The mean surgical procedure length was 50 min (range 20-100 min). In all the cases the nodule was resected and the resection margins were pathologically free of tumour. The mean post-operative hospital stay was 3 days (range 2-6 days). Histological examination showed 21 benign lesions and 18 malignant lesions (seven metastases and 11 primary lung cancers). Nine pts with primary lung carcinoma underwent a completion lobectomy by open surgery.
Radiolocalization by gamma-probe allows the detection and exeresis of small nodules in a easy and safe way. Future and predictable advances in radio-marked monoclonal antibodies, as well as in the development of endoscopic beta-detector probe, will offer a more effective method for detection of primary and metastatic tumours, targets of thoracoscopic resections.
电视辅助胸腔镜手术（VATS）是一种用于诊断和治疗周围型肺结节的有趣且新兴的手术方法。然而，胸腔镜在检测位于胸膜表面以下、肺实质深处的小结节方面存在局限性，这些小结节往往触诊比可视更多。定位此类病变的方法，包括注射亚甲蓝或在影像学引导下插入带钩金属丝，虽有一些优点，但也有很多局限性。我们正在开发一种新技术，用于检测位于肺实质深处、直径小于2cm的肺结节。
该技术包括在手术前2小时，在CT扫描引导下向病灶内注射0.3ml 99m Tc标记的人血清白蛋白微球溶液（5 - 10MBq）。在胸腔镜检查期间，通过一个11.5mm的套管针插入一个连接到γ射线探测器（Scinti Probe MR 100 - Pol. hi.tech., Aquila - 意大利）的直径11mm的准直探头，并对可疑区域的胸膜表面进行扫描。一个热点表明注射的结节存在，从而确定需要切除的区域。
从1997年6月至1999年6月，我们治疗了39例小肺结节患者。患者中男性27例，女性12例，平均年龄60.8岁（范围：13 - 80岁）。19例患者有同步或异时性恶性肿瘤病史。平均手术时间为50分钟（范围20 - 100分钟）。所有病例中的结节均被切除，切除边缘病理检查无肿瘤。术后平均住院时间为3天（范围2 - 6天）。组织学检查显示21例良性病变和18例恶性病变（7例转移瘤和11例原发性肺癌）。9例原发性肺癌患者通过开放手术进行了全肺叶切除术。
γ探头放射性定位能够以简便、安全的方式检测和切除小结节。放射性标记单克隆抗体未来可预见的进展，以及内镜β探测器探头的开发，将为检测胸腔镜切除的原发性和转移性肿瘤靶点提供更有效的方法。
