Yoshida Yukihiro, Inoh Shinichi, Murakawa Tomohiro, Ota Satoshi, Fukayama Masashi, Nakajima Jun
Department of Cardiothoracic Surgery, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Interact Cardiovasc Thorac Surg. 2011 Jul;13(1):25-8. doi: 10.1510/icvts.2011.266932. Epub 2011 Apr 11.
The outcome of computed tomography (CT)-guided percutaneous marking for the preoperative localization of small peripheral pulmonary nodules was analyzed retrospectively. This procedure, in which 21-gauge markers were placed near nodules under local anesthesia on the day of surgery, concerned the patients who received video-assisted thoracoscopic surgery as a primary operative technique. The study included all the 57 patients who underwent CT-guided percutaneous marking before pulmonary resection. The mean nodule size was 1.1 cm. Pneumothorax and pulmonary bleeding were observed in 28 and 17 patients, respectively. Other complications included pain (four), subcutaneous bleeding (two) and dislodgment of the marker (one). Wedge resection during thoracotomy was necessary in seven patients because of severe adhesions (four), multiple wedge resections (one), dislodgment of the marker (one) and difficulty in identifying a nodule (one). Pathological studies revealed 24 metastatic lung tumors, 19 bronchioloalveolar carcinomas (BACs), five adenocarcinomas with mixed subtypes, three granulomas, two atypical adenomatous hyperplasias and six miscellaneous others. Wedge resection for malignancy was performed in 39 patients with 41 lesions. The median follow-up period was 46 months. A positive surgical margin and recurrence at the surgical stump were observed in one case each. In conclusion, preoperative CT-guided marking was safe and effective, although marker dislodgment, positive surgical margin and recurrence at the surgical stump were observed infrequently.
回顾性分析计算机断层扫描（CT）引导下经皮标记对小的外周肺结节进行术前定位的结果。该操作是在手术当天于局部麻醉下将21号标记物放置在结节附近，涉及以电视辅助胸腔镜手术作为主要手术技术的患者。该研究纳入了所有57例在肺切除术前接受CT引导下经皮标记的患者。结节平均大小为1.1厘米。分别在28例和17例患者中观察到气胸和肺出血。其他并发症包括疼痛（4例）、皮下出血（2例）和标记物移位（1例）。由于严重粘连（4例）、多次楔形切除（1例）、标记物移位（1例）和难以识别结节（1例），7例患者在开胸手术期间需要进行楔形切除。病理研究显示有24例转移性肺肿瘤、19例细支气管肺泡癌（BAC）、5例混合型腺癌、3例肉芽肿、2例非典型腺瘤样增生和6例其他杂类。39例有41个病灶的恶性肿瘤患者进行了楔形切除。中位随访期为46个月。各有1例观察到手术切缘阳性和手术残端复发。总之，术前CT引导下标记是安全有效的，尽管标记物移位、手术切缘阳性和手术残端复发很少见。
