Zhou Jian-Hua, Li Wen-Tao, Chen Hai-Quan, Peng Wei-Jun, Xiang Jia-Qing, Zhang Ya-Wei, Wang Sheng-Ping, Yang Fu, Zhou Xian, Luo Xiao-Yang
Department of Thoracic Surgery, Cancer Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Zhong Liu Za Zhi. 2009 Jul;31(7):546-9.
Video-assisted thoracoscopic surgery (VATS) provides a minimally invasive approach to resect small solitary pulmonary nodules (SSPN). The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS.
Hookwire was used to localize 26 SSPN under CT guidance in 24 patients (14 male, 10 female, age range 21-61 years, mean 52.3 years), preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated.
All the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT-guidance. The mean lesion size was 10.05 +/- 3.08 mm in diameter, and the mean distance from lesion to parietal pleura was 10.09 +/- 2.62 mm. The mean localization time was 20.18 +/- 7.16 min, and then the nodules were removed by VATS within 18 +/- 6.65 min. The major complication of CT-guided hookwire localization was mild pneumothorax in 6 patients (25.0%), but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient (4.2%) during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobectomies were performed.
The preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.
电视辅助胸腔镜手术（VATS）为切除小的孤立性肺结节（SSPN）提供了一种微创方法。本研究的目的是评估术前CT引导下钩丝定位对VATS中SSPN的有效性和安全性。
术前在CT引导下用钩丝对24例患者（14例男性，10例女性，年龄范围21 - 61岁，平均52.3岁）的26个SSPN进行定位，然后通过VATS进行楔形切除术。评估病变大小、病变距脏层胸膜的距离、定位时间和并发症。
所有26个肺结节术前均在CT引导下用钩丝检测并定位。平均病变直径为10.05±3.08mm，病变距脏层胸膜的平均距离为10.09±2.62mm。平均定位时间为20.18±7.16分钟，然后在18±6.65分钟内通过VATS切除结节。CT引导下钩丝定位的主要并发症是6例患者（25.0%）出现轻度气胸，但无人需要胸腔闭式引流。术中仅1例患者（4.2%）发现钩丝移位，但在VATS下仍成功切除病变。在这些患者中，8例在VATS楔形切除术中通过快速病理诊断确诊为原发性非小细胞肺癌（NSCLC），随后进行了VATS肺叶切除术。
术前CT引导下对小的孤立性肺结节进行钩丝定位是辅助VATS切除结节的一种有效且安全的技术。
