Miura Hiroshi, Yamagami Takuji, Tanaka Osamu, Yoshimatsu Rika, Ichijo Yusuke, Kato Daishiro, Shimada Junichi
Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
Department of Radiology, Kochi University, Kochi, Japan.
Acta Radiol. 2016 Mar;57(3):303-10. doi: 10.1177/0284185115576047. Epub 2015 Mar 19.
In preoperative lipiodol marking for small pulmonary nodules, lipiodol has a potential risk of distribution in the surrounding lung structure. There are no reports about the detailed accumulation and distribution of lipiodol.
To evaluate computed tomography (CT) findings after lipiodol marking before thoracoscopic surgery for pulmonary nodules.
Sixty-four consecutive CT-guided lipiodol markings for 103 nodules were performed in 55 patients. Lipiodol (0.2-0.4 mL) was injected using a 21-gauge needle near the nodule. The appearance of lipiodol spots was classified into the following three types on CT: type 1, dense; type 2, punctate; and type 3, unclear. The distribution of lipiodol was also investigated. Statistical analyses were performed on the accumulation and distribution related to nodule factors. Incidences of complications were also investigated.
A total of 110 markings were performed because of seven additional procedures due to insufficient marking. All nodules were successfully resected on the same day. The appearances of the lipiodol spots were type 1 (82%), type 2 (11%), and type 3 (7.3%). The areas of distribution were lung parenchyma (54%), central bronchus (39%), peripheral bronchovascular bundle (24%), needle tract (20%), pleural space (19%), another segment of ipsilateral lung (5.5%), and contralateral lung (0.9%). Distribution into pleural space and central bronchus was frequently seen in the shallow nodules (P < 0.05). Complications were pneumothorax (61%) and pulmonary hemorrhage (35%). There were no serious symptoms.
The appearance of the lipiodol spot was dense in most cases, despite frequent distribution in the surrounding lung structures without serious complications.
在术前对小肺结节进行碘油标记时，碘油有在周围肺组织中扩散的潜在风险。目前尚无关于碘油详细聚集和分布情况的报道。
评估肺结节胸腔镜手术前碘油标记后的计算机断层扫描（CT）表现。
对55例患者的103个结节连续进行了64次CT引导下的碘油标记。使用21号针在结节附近注入碘油（0.2 - 0.4 mL）。CT上碘油斑的表现分为以下三种类型：1型，浓密型；2型，点状型；3型，不清晰型。同时研究碘油的分布情况。对与结节因素相关的聚集和分布进行了统计分析。还调查了并发症的发生率。
由于标记不足进行了7次额外操作，共进行了110次标记。所有结节均在同一天成功切除。碘油斑的表现为1型（82%）、2型（11%）和3型（7.3%）。分布区域为肺实质（54%）、中央支气管（39%）、外周支气管血管束（24%）、针道（20%）、胸腔（19%）、同侧肺另一肺段（5.5%）和对侧肺（0.9%）。浅部结节中碘油进入胸腔和中央支气管的情况较为常见（P < 0.05）。并发症为气胸（61%）和肺出血（35%）。无严重症状。
尽管碘油在周围肺组织中扩散频繁，但多数情况下碘油斑表现为浓密型，且无严重并发症。
