Barmin Vitaly, Sadovnichy Victor, Sokolov Mikhail, Pikin Oleg, Amiraliev Ali
Department of Thoracic Surgery, P.A. Herzen Moscow Oncology Research Institute, Moscow, Russian Federation Lomonosov Moscow State University, Moscow, Russian Federation
Lomonosov Moscow State University, Moscow, Russian Federation.
Eur J Cardiothorac Surg. 2014 Dec;46(6):1027-31. doi: 10.1093/ejcts/ezu161. Epub 2014 Apr 16.
The purpose of this study was to evaluate the efficiency of our newly designed tactile mechanoreceptor in detection of pulmonary lesions during thoracoscopy.
Twenty-seven patients with peripheral undetermined subpleural solitary pulmonary lesions detected on computed tomography were included in a prospective non-randomized trial. All nodules from 7 to 18 mm in diameter were located deep in the lung parenchyma (≥ 10 mm from the lung surface). All patients underwent thoracoscopic exploration with diagnostic intent. Instrumental palpation with lung forceps was performed first, followed by thorough inspection of lung tissue with the tactile mechanoreceptor. This device is a metal tube 10 mm in diameter, which can be inserted into the pleural cavity via a standard 10-mm port. There is an elastic membrane on its working end, which deforms greatly if the palpated tissue has greater density. Intraoperatively, the surgeon pushed the targeted region of pulmonary tissue with the mechanoreceptor and carried out the measurement. The density of tissue characteristics was displayed with special software using colour change in real time. After detection of a pulmonary nodule, it was resected with endostaplers.
Instrumental palpation was successful in detection of pulmonary lesions in 10 (37%) patients and was confirmed with the tactile mechanoreceptor. In 12 (44%) patients, instrumental palpation failed to locate an intrapulmonary nodule, while the tactile mechanoreceptor facilitated finding the lesion and performing thoracoscopic lung resection in all these patients. Intraoperative histological examination confirmed benign disease in 8, metastatic lesion in 12 and primary lung cancer in 7 patients requiring thoracoscopic lobectomy. In 5 (19%) patients, neither forceps nor the tactile mechanoreceptor was able to detect any pulmonary lesion, necessitating mini-thoracotomy for finger palpation. The overall efficacy of the tactile mechanoreceptor in detection of pulmonary lesions was 81%, and of impalpable nodes 71%.
The tactile mechanoreceptor is an effective tool for detection of impalpable pulmonary lesions during thoracoscopy.
本研究旨在评估我们新设计的触觉机械感受器在胸腔镜检查中检测肺部病变的效率。
27例在计算机断层扫描上发现外周未明确的胸膜下孤立性肺病变的患者纳入一项前瞻性非随机试验。所有直径7至18毫米的结节均位于肺实质深处（距肺表面≥10毫米）。所有患者均接受了以诊断为目的的胸腔镜探查。首先用肺钳进行器械触诊，然后用触觉机械感受器对肺组织进行全面检查。该装置是一根直径10毫米的金属管，可通过标准的10毫米端口插入胸腔。其工作端有一个弹性膜，如果触诊的组织密度较大，该膜会发生很大变形。术中，外科医生用机械感受器推动肺组织的目标区域并进行测量。使用特殊软件通过颜色变化实时显示组织特征的密度。检测到肺结节后，用吻合器将其切除。
器械触诊在10例（37%）患者中成功检测到肺部病变，并经触觉机械感受器证实。在12例（44%）患者中，器械触诊未能定位肺内结节，而触觉机械感受器有助于在所有这些患者中找到病变并进行胸腔镜肺切除术。术中组织学检查证实8例为良性疾病，12例为转移性病变，7例为原发性肺癌，这些患者需要进行胸腔镜肺叶切除术。在5例（19%）患者中，钳夹和触觉机械感受器均未能检测到任何肺部病变，需要进行小切口开胸用手指触诊。触觉机械感受器检测肺部病变的总体效率为81%，对不可触及结节的检测效率为71%。
触觉机械感受器是胸腔镜检查中检测不可触及肺部病变的有效工具。
