Asano Fumihiro, Shindoh Joe, Shigemitsu Kikuo, Miya Kiichi, Abe Takashi, Horiba Michiaki, Ishihara Yoichiro
Department of Internal Medicine, National Health Insurance Sekigahara Hospital, 2490-29 Sekigahara-cho, Fuwa-gun, Gifu 503-1514, Japan.
Chest. 2004 Nov;126(5):1687-93. doi: 10.1378/chest.126.5.1687.
To facilitate marking and to reduce its complications, we performed barium marking using an ultrathin bronchoscope with virtual bronchoscopic (VB) navigation before thoracoscopic surgery for small pulmonary peripheral lesions. We then evaluated the feasibility, safety, and efficacy of this technique.
A pilot study.
A tertiary teaching hospital.
The subjects were consecutive patients with small pulmonary peripheral lesions (ie, </= 10 mm) showing a CT scan-confirmed pure ground-glass opacity pattern between December 2001 and August 2003.
VB images to the planned marking sites near each lesion were produced from helical CT scan data. Based on these images, an ultrathin bronchoscope was advanced to the target bronchus under direct vision. Under CT scan and radiographic fluoroscopy, a catheter was inserted to the planned site via the bronchoscope, and barium sulfate suspension was instilled for marking.
The subjects were 23 patients (8 men and 15 women) who had a total of 31 lesions. The bronchial branching patterns seen in VB images were highly consistent with those confirmed using the ultrathin bronchoscope. Therefore, the ultrathin bronchoscope could be guided under direct vision to a median of the sixth generation bronchi (range, fourth to ninth generation bronchi) toward the planned marking sites. Marking was achieved without causing complications in any of the patients. The median marking time was 23.5 min, and the median shortest distance between the barium marker and the lesion was 4 mm (within 10 mm in 27 lesions). In patients undergoing thoracoscopic surgery, all barium-marked sites were identified by intraoperative radiographic fluoroscopy, and all lesions were resected. A pathologic examination demonstrated primary lung cancer in 17 lesions (bronchioloalveolar carcinoma, 15; adenocarcinoma, 2), atypical adenomatous hyperplasia in 12 lesions, and pneumonia in 2 lesions.
This method can be readily performed without complications and is a useful marking method before thoracoscopic surgery for small pulmonary peripheral lesions.
为便于标记并减少其并发症，我们在胸腔镜手术治疗小的肺外周病变前，使用带有虚拟支气管镜（VB）导航的超细支气管镜进行了钡剂标记。然后我们评估了该技术的可行性、安全性和有效性。
一项初步研究。
一家三级教学医院。
研究对象为2001年12月至2003年8月期间连续收治的小的肺外周病变（即直径≤10mm）患者，其CT扫描显示为确诊的纯磨玻璃影模式。
根据螺旋CT扫描数据生成各病变附近计划标记部位的VB图像。基于这些图像，在直视下将超细支气管镜推进至目标支气管。在CT扫描和放射荧光透视下，通过支气管镜将导管插入计划部位，并注入硫酸钡混悬液进行标记。
研究对象为23例患者（8例男性和15例女性），共有31个病变。VB图像中所见的支气管分支模式与使用超细支气管镜确认的模式高度一致。因此，超细支气管镜可在直视下被引导至第六级支气管（范围为第四至第九级支气管）的中位部位，朝向计划标记部位。所有患者均未发生并发症而成功完成标记。中位标记时间为23.5分钟，钡剂标记与病变之间的最短中位距离为4mm（27个病变在10mm以内）。在接受胸腔镜手术的患者中，术中放射荧光透视均识别出所有钡剂标记部位，所有病变均被切除。病理检查显示17个病变为原发性肺癌（细支气管肺泡癌15例，腺癌2例），12个病变为非典型腺瘤样增生，2个病变为肺炎。
该方法操作简便，无并发症，是胸腔镜手术治疗小的肺外周病变前一种有用的标记方法。
