Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
J Pediatr Surg. 2013 Apr;48(4):750-6. doi: 10.1016/j.jpedsurg.2012.09.051.
Detection and treatment of small lung nodules are important in managing pediatric cancer. We studied the effectiveness of preoperative localization of pulmonary nodules by CT-guided needle hook wire placement followed by thoracoscopic resection in children with cancer.
We reviewed records of patients who underwent thoracoscopic resection of lung nodules localized preoperatively with CT-guided needle and hook wire placement at our hospital between March 1999 and April 2010 for nodule characteristics and outcomes of procedure.
Thirty-seven patients (median age, 14years) with osteosarcoma or other cancers underwent thoracoscopic resection of needle-localized lung nodules. Lesion (median nodule size, 4mm) location was left lung (n=11), right lung (n=19), and bilateral (n=7). The procedure was successful in 36 (97.3%) patients. Five patients had a pneumothorax after localization but none required chest tube placement before thoracoscopy. All patients underwent thoracoscopy, but 4 required conversion to open thoracotomy. During thoracoscopic inspection, the hook wire slipped out of the lesion in 6 patients, of whom 1 needed thoracotomy to locate nodule. Lesions (malignant in 13 patients) were removed in all patients. Five patients with benign lesions had recurrent malignant lung nodules.
Thoracoscopic resection of preoperatively localized small lung nodules is a safe and effective procedure in children.
在儿童癌症的治疗中，对肺部小结节的检测和处理非常重要。我们研究了 CT 引导下针钩线定位后行胸腔镜切除术对癌症患儿肺部小结节的定位效果。
我们回顾了 1999 年 3 月至 2010 年 4 月期间在我院接受 CT 引导下针钩线定位行胸腔镜切除术的 37 例肺部结节患者的病历，记录了患者的结节特征和手术结果。
37 例骨肉瘤或其他癌症患者接受了胸腔镜下切除经针钩线定位的肺部小结节。病变（结节大小中位数为 4mm）位于左肺（n=11）、右肺（n=19）和双侧（n=7）。36 例（97.3%）患者的定位过程取得成功。5 例患者在定位后出现气胸，但均无需在胸腔镜手术前放置胸腔引流管。所有患者均接受了胸腔镜检查，但有 4 例需要转为开胸手术。在胸腔镜检查过程中，6 例患者的钩线从病变处滑出，其中 1 例需要开胸定位结节。所有患者的病变（恶性 13 例）均被切除。5 例良性病变患者出现恶性肺部结节复发。
在儿童中，经术前定位的胸腔镜切除小肺结节是一种安全有效的手术方法。
