Martin Abigail E, Chen James Y, Muratore Christopher S, Mayo-Smith William W, Luks Francois I
Hasbro Children's Hospital, Warren Alpert Medical School, BrownUniversity, Providence, Rhode Island, USA.
J Laparoendosc Adv Surg Tech A. 2009 Apr;19 Suppl 1:S161-4. doi: 10.1089/lap.2008.0143.supp.
Thoracoscopic wedge resection has gained widespread acceptance as a method of resecting pulmonary metastases in pediatric cancer patients. This is most successful for lesions on the pleural surface that can be identified without palpation. Deeper lesions can be marked by preoperative computed tomography (CT)-guided techniques, but neither needle localization nor dye injection alone is foolproof. In this paper, we present our experience with a dual localization technique.
Under CT guidance, a 20-G needle is advanced to within 1 cm of the lesion and 0.1 mL of methylene blue: Low osmolar contrast (4:1 ratio) is injected. A Kopans breast biopsy hook wire is then introduced through the needle and its tip placed within the lesion. Its tail is cut flush with the chest wall. The patient is transferred to the operating room, and a wedge resection around the hook wire is performed thoracoscopically.
Six deep pulmonary metastatic lesions were preoperatively localized in 4 pediatric patients (ages, 6-17).Median localization time was 30 minutes. All lesions were successfully marked and identified at operation.Margin-free resection of the lesion was successful in all cases.
Thoracoscopic resection of metastatic pulmonary lesions in children, using preoperative localization with both wire localization and methylene blue/contrast injection, is safe and effective. This method allows the successful localization of lesions, even in the event of either dislodgement of the wire or over infusion of the methylene blue dye.
胸腔镜楔形切除术作为小儿癌症患者肺转移瘤的切除方法已被广泛接受。对于无需触诊即可识别的胸膜表面病变，这种方法最为成功。较深的病变可通过术前计算机断层扫描（CT）引导技术进行标记，但单独的针定位或染料注射都并非万无一失。在本文中，我们介绍了我们使用双重定位技术的经验。
在CT引导下，将一根20G的针推进到距病变1厘米以内，注入0.1毫升亚甲蓝：低渗造影剂（比例为4:1）。然后将一根科潘斯乳腺活检钩丝通过针插入，其尖端置于病变内。将其尾部与胸壁齐平剪断。患者被转移至手术室，通过胸腔镜围绕钩丝进行楔形切除术。
4例小儿患者（年龄6 - 17岁）术前对6个深部肺转移瘤进行了定位。定位时间中位数为30分钟。所有病变在手术中均成功标记并识别。所有病例均成功进行了病变的无瘤切除。
对于小儿转移性肺病变，采用术前钢丝定位和亚甲蓝/造影剂注射双重定位技术进行胸腔镜切除是安全有效的。即使在钢丝移位或亚甲蓝染料注射过量的情况下，这种方法也能成功定位病变。
