Iguchi Toshihiro, Hiraki Takao, Gobara Hideo, Fujiwara Hiroyasu, Matsui Yusuke, Sugimoto Seiichiro, Toyooka Shinichi, Oto Takahiro, Miyoshi Shinichiro, Kanazawa Susumu
Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan,
Cardiovasc Intervent Radiol. 2015 Feb;38(1):222-6. doi: 10.1007/s00270-014-0862-9. Epub 2014 Feb 20.
We retrospectively evaluated the results of the transfissural route for preoperative localization with a short hook wire and suture system for video-assisted thoracoscopic surgery (VATS).
Eleven patients with 11 tumors underwent CT-guided transfissural placement of a hook wire before VATS. This route was selected for all patients, because the distance between the tumor and interlobar fissure was much shorter than the required distance traversed using the conventional approach. Complications were evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0.
The hook wire was successfully placed using the transfissural route in all but one case. Of these ten successful placements, two tumors needed a second puncture for optimal placement, because the CT scan showed that the first hook wire was not properly placed in the lung. In one patient, we did not attempt replacement after the first placement was incorrect. In ten successful procedures, the mean distance traversed in the parenchyma of the unaffected lung lobe was 27.9 mm. The distance between the pleura and placed hook wire was significantly shorter than the estimated distance between the pleura and hook wire using the conventional route (mean 16.3 vs. 40.9 mm; P = 0.0002). Grade 1 adverse events occurred (11 pneumothoraxes and 4 pulmonary hemorrhages). No grade 2 or higher adverse event was observed.
The transfissural route used for preoperative localization before VATS is useful for selected patients because this route may allow for more limited lung parenchyma resection.
我们回顾性评估了经裂孔路径使用短钩丝和缝线系统进行术前定位，用于电视辅助胸腔镜手术（VATS）的结果。
11例患有11个肿瘤的患者在VATS术前接受了CT引导下经裂孔放置钩丝。所有患者均选择此路径，因为肿瘤与叶间裂之间的距离比使用传统方法所需穿过的距离短得多。使用美国国立癌症研究所不良事件通用术语标准第4.0版评估并发症。
除1例患者外，所有患者均通过经裂孔路径成功放置了钩丝。在这10次成功放置中，有2个肿瘤需要第二次穿刺以实现最佳放置，因为CT扫描显示第一根钩丝在肺内放置不当。在1例患者中，第一次放置不正确后我们未尝试更换。在10次成功的手术中，未受影响肺叶实质内穿过的平均距离为27.9毫米。胸膜与放置的钩丝之间的距离明显短于使用传统路径时胸膜与钩丝之间的估计距离（平均16.3对40.9毫米；P = 0.0002）。发生了1级不良事件（11例气胸和4例肺出血）。未观察到2级或更高等级的不良事件。
VATS术前定位使用的经裂孔路径对选定患者有用，因为该路径可能允许更有限的肺实质切除。
