Poretti F P, Brunner E, Vorwerk D
Institut für diagnostische und interventionelle Radiologie des Klinikums Ingolstadt, Germany.
Rofo. 2002 Feb;174(2):202-7. doi: 10.1055/s-2002-20100.
Video-assisted thoracoscopic surgery (VATS) is an alternative approach to small intrapulmonary nodules, if transbronchial or percutaneous biopsy have failed. We investigated the feasibility and effectiveness of the percutaneous CT-guided placement of hook-wires to localize such nodules before video-assisted thoracoscopy.
19 patients with new by diagnosed intrapulmonary nodules underwent CT-guided hook-wire localization by application of a X-Reidy -Set (Cook, Inc., Bjaeverskov, Denmark). The average age of the patient was 63 years (range: 19 - 80 years), the mean distance between the nodule and the pleura visceral was 7.58 mm (range: 0 - 25 mm) and the mean diameter was 11.58 mm (range: 5 - 25 mm). After localization, the patients underwent a VATS resection of the lesion within a mean time of 30 min (range 10 - 48 min).
In all cases, resection of the nodules was successful. In 4 older patients the marking was complicated by poor cooperability. At the end of manipulation the end of the hook was distanced from the nodule. But also in these cases, resection was successfully performed. 8 patients developed an asymptomatic pneumothorax: 5 of them in a minor (max. 1.5 cm rim), three of them in a moderate (max. 3 cm rim) dimension. In 4 patients, in whom the tumor was hit directly by the needle, local bleeding occurred. In one case, haemoptoe was present. In no patient did a dislocation of the hookwire-system occur.
CT-guided placement of a hook-wire system is a simple and reasonable procedure which facilitates safe VATS resection of small pulmonary nodules.
如果经支气管或经皮活检失败，电视辅助胸腔镜手术（VATS）是治疗小的肺内结节的另一种方法。我们研究了在电视辅助胸腔镜检查前经皮CT引导下放置钩丝定位此类结节的可行性和有效性。
19例新诊断的肺内结节患者采用X-Reidy-Set（丹麦比耶弗斯科夫库克公司）进行CT引导下钩丝定位。患者的平均年龄为63岁（范围：19 - 80岁），结节与脏层胸膜之间的平均距离为7.58 mm（范围：0 - 25 mm），平均直径为11.58 mm（范围：5 - 25 mm）。定位后，患者在平均30分钟（范围10 - 48分钟）内接受了VATS病变切除术。
所有病例中，结节切除均成功。在4例老年患者中，由于配合不佳，标记过程较为复杂。操作结束时，钩的末端与结节有一定距离。但在这些病例中，切除也成功进行。8例患者出现无症状气胸：其中5例为少量气胸（最大边缘1.5 cm），3例为中等量气胸（最大边缘3 cm）。4例患者因针直接刺入肿瘤而出现局部出血。1例患者出现咯血。没有患者发生钩丝系统脱位。
CT引导下放置钩丝系统是一种简单合理的方法，有助于安全地通过VATS切除小的肺结节。
