Department of Thoracic Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan.
Department of Thoracic Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan.
Ann Thorac Surg. 2013 Oct;96(4):1203-1208. doi: 10.1016/j.athoracsur.2013.05.026. Epub 2013 Jul 26.
Video-assisted thoracic surgery offers a minimally invasive method for diagnosing and treating small pulmonary lesions, although the localization of these lesions is sometimes problematic. Various localization methods have been reported but few studies have described their efficacy and adverse events.
We performed computed tomography (CT)-guided localization using a hook wire in 417 patients with 500 lesions treated between January 2006 and December 2010.
We located 178 lesions with a ground-glass opacity component and 322 solid lesions. The solid lesions had smaller tumor diameters and were located further from the pleura. Tumor depth to size ratio was 0.9 ± 0.9 for the lesions with a ground-glass opacity component and 1.8 ± 1.5 for the solid lesions (p < 0.001). Pneumothorax requiring aspiration was observed in 4.6% patients, and hemoptysis and pulmonary hematoma was observed in 10.3%. Systemic air embolism with no sequelae and spontaneous resolution occurred in a patient (0.24%). The morbidity rate was 15.1%. Male patients, patients who had undergone multiple localization, and heavy smokers were at a higher risk of pneumothorax requiring aspiration. Insertion distance more than 25 mm was a risk factor for hemoptysis and pulmonary hematoma (p < 0.001). Procedure duration per lesion was 14 ± 5 minutes. Dislodgement occurred in 2 patients (0.4%).
The safety, reliability, and convenience of CT-guided hook wire localization are acceptable. Localization for lesions with a ground-glass opacity component may be performed when the lesions are relatively large and shallow. Insertion distances greater than 25 mm are associated with a risk of pulmonary hematoma and hemoptysis.
电视辅助胸腔镜手术为诊断和治疗小的肺部病变提供了一种微创方法，但这些病变的定位有时存在问题。已经报道了各种定位方法，但很少有研究描述其疗效和不良事件。
我们在 2006 年 1 月至 2010 年 12 月期间对 417 例 500 个病变的患者进行了 CT 引导下的钩线定位。
我们定位了 178 个有磨玻璃成分的病变和 322 个实体病变。实体病变的肿瘤直径较小，且距胸膜较远。磨玻璃成分病变的肿瘤深度与大小比为 0.9 ± 0.9，实体病变为 1.8 ± 1.5（p < 0.001）。4.6%的患者需要抽吸气胸，10.3%的患者出现咯血和肺血肿。1 例（0.24%）患者发生无后遗症的全身空气栓塞并自行缓解。发病率为 15.1%。男性患者、接受多次定位的患者和重度吸烟者发生气胸需要抽吸的风险较高。插入距离超过 25 毫米是咯血和肺血肿的危险因素（p < 0.001）。每个病变的手术时间为 14 ± 5 分钟。2 例（0.4%）患者发生移位。
CT 引导下钩线定位的安全性、可靠性和便利性是可以接受的。当病变相对较大且较浅时，可以对磨玻璃成分的病变进行定位。插入距离大于 25 毫米与肺血肿和咯血的风险相关。
