Ambrogi M C, Dini P, Boni G, Melfi F, Lucchi M, Fanucchi O, Mariani G, Mussi A
Division of Thoracic Surgery, Cardiac and Thoracic Department, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
Surg Endosc. 2005 Dec;19(12):1644-7. doi: 10.1007/s00464-005-0087-8. Epub 2005 Oct 3.
Preoperative procedures are often necessary to localize pulmonary nodules during thoracoscopic resection in order to reduce the necessity of resorting to thoracotomy. The aim of this report is to describe the strategy we developed to limit preoperative techniques without reducing the thoracoscopic success rate of localization.
Between January 2000 and December 2003, 183 patients underwent video thoracoscopic resection of small pulmonary nodules. The patients were divided into two groups on the basis of the radiological features of the nodule. The subjects in group 1 were operated on directly, and endothoracic ultrasonography was performed when necessary. The subjects in group 2 underwent preoperative radionuclide labeling of the nodule.
In group 1, 112 out of 119 nodules (94%) were localized. Twenty-five out of 32 lesions, neither visible nor palpable, were found by endothoracic ultrasonography. In group 2, we localized 62 out of 64 nodules (97%).
Currently, we cannot completely avoid preoperative labeling techniques for thoracoscopic resection of small pulmonary nodules. However, correct patient selection may limit this necessity, without an increased conversion rate to thoracotomy, if endothoracic ultrasonography is available.
在胸腔镜切除术中，术前操作对于定位肺结节往往是必要的，以便减少开胸手术的必要性。本报告的目的是描述我们制定的策略，即在不降低胸腔镜定位成功率的情况下限制术前技术的使用。
2000年1月至2003年12月期间，183例患者接受了电视胸腔镜下小肺结节切除术。根据结节的放射学特征将患者分为两组。第1组患者直接进行手术，必要时进行胸腔内超声检查。第2组患者对结节进行术前放射性核素标记。
第1组中，119个结节中有112个（94%）被定位。胸腔内超声检查发现32个既不可见也不可触及的病变中有25个。第2组中，64个结节中有62个（97%）被定位。
目前，我们无法完全避免对小肺结节进行胸腔镜切除术前的标记技术。然而，如果有胸腔内超声检查，正确选择患者可能会限制这种必要性，而不会增加开胸手术的转化率。
