Gruppioni F, Piolanti M, Coppola F, Papa S, Di Simone M, Albini L, Mattioli S, Gavelli G
Dipartimento Clinico di Scienze Radiologiche ed Istocitopatologiche, Radiodiagnostica III, Policlinico S. Orsola-Malpighi dell'Università , Bologna.
Radiol Med. 2000 Oct;100(4):223-8.
One of the major limitations of thoracoscopic resection of lung nodules is localization of the target, especially when the lesion is deep or very small: we investigated the efficacy of US as a technique for intraoperative localization.
We examined 11 patients who underwent diagnostic and/or curative thoracoscopic resection of benign or malignant, primary or metastatic lung nodules. The study was preceded by a preliminary phase in which we examined with US 5 patients that underwent thoracotomy. A multifrequency laparoscopic US probe with a deflectable linear headpiece mounted on a portable Esaote-Hitachi Spazio US unit was used.
The US exploration of the lung requires the complete collapse of the parenchyma and is therefore particularly difficult in patients with severe chronic obstructive pulmonary disease (COPD). In the patients examined during thoracotomy US showed all the lesions but one 7-mm nodule in an emphysematous patient in whom complete parenchyma collapse could not be achieved. Also in the patients examined during thoracoscopy US detected all the targets (13/13), even a 13-mm metastatic nodule which had been visualized preoperatively by PET only. The smallest lesion found was a 4-mm fibrosarcoma metastasis. The mean time to achieve adequate lung collapse was about 40 minutes from selective exclusion of the affected lung.
Thoracoscopic US has been recently introduced for the intraoperative localization of pulmonary nodules. In our experience this technique is helpful in localizing the targets, assessing the extent of surgical resection and studying possible vascular involvement. Considering the easy execution, the low cost, the lack of contraindications and complications of the technique and its accuracy when performed under optimal technical conditions, we think there are enough reasons to investigate this approach further.
Intraoperative US proved to be a useful technique of easy execution, even though it is heavily operator-dependent and limited in patients with severe COPD.
胸腔镜下肺结节切除术的主要局限之一是目标定位，尤其是当病变位置较深或非常小时：我们研究了超声作为一种术中定位技术的有效性。
我们检查了11例行诊断性和/或根治性胸腔镜下良性或恶性、原发性或转移性肺结节切除术的患者。在该研究之前有一个预备阶段，我们对5例行开胸手术的患者进行了超声检查。使用了一个安装在便携式百胜-日立Spazio超声设备上的带可弯曲线性探头的多频率腹腔镜超声探头。
肺部的超声探查需要肺实质完全萎陷，因此在患有严重慢性阻塞性肺疾病（COPD）的患者中尤为困难。在开胸手术期间检查的患者中，超声显示了所有病变，但在一名肺气肿患者中，一个7毫米的结节未被显示，因为无法实现肺实质的完全萎陷。同样，在胸腔镜检查期间检查的患者中，超声检测到了所有目标（13/13），甚至包括一个术前仅通过PET显影的13毫米转移瘤。发现的最小病变是一个4毫米的纤维肉瘤转移灶。从选择性阻断患侧肺开始，达到充分肺萎陷的平均时间约为40分钟。
胸腔镜超声最近已被用于肺结节的术中定位。根据我们的经验，该技术有助于定位目标、评估手术切除范围以及研究可能的血管受累情况。考虑到该技术操作简便、成本低、无禁忌证和并发症，并且在最佳技术条件下执行时准确性高，我们认为有充分理由进一步研究这种方法。
术中超声被证明是一种操作简便的有用技术，尽管它严重依赖操作者，并且在患有严重COPD的患者中受限。
