Zhao Ze-Rui, Lau Rainbow W H, Ng Calvin S H
1 Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China ; 2 State Key Laboratory of Oncology in Southern China, Collaborative Innovation Centre for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-Sen University Cancer Centre, Guangzhou 510060, China.
J Thorac Dis. 2016 Mar;8(Suppl 3):S319-27. doi: 10.3978/j.issn.2072-1439.2016.02.27.
Management of pulmonary nodules in terms of diagnosis and intraoperative localization can be challenging, especially in the minimal invasive video-assisted thoracoscopic surgery (VATS) approach, and may be even more difficult with single port VATS with limited access. The ability to localize small lesions intraoperatively is particularly important for excisional biopsy for diagnostic frozen section, as well as to guide sublobar resection. Some of the common techniques to aid localization include preoperative percutaneous hookwire localization, colour dye or radio-dye labelling injection of the nodule or adjacent site to allowing visualization or detection by radioactive counter intraoperatively. The use of hybrid operating room (OR) for intraoperative localization of lung nodules was first reported in 2013, and was called image guided VATS (iVATS). Subsequently, we have expanded the iVATS application for single port VATS major lung resection of small or ground-glass opacity lesions. By performing an on-table cone-beam CT scan, real-time and accurate assessment of the pulmonary lesion can be made, which can aid the localization process. Other types of physical or colour marker that can be deployed percutaneously in the hybrid OR immediate before surgery can enhance haptic feedback and sensitivity of digital palpation, as well as provide a radiopaque nidus for radiological confirmation. In the past decade, the electromagnetic navigation bronchoscopy (ENB) technology had developed into a useful adjunct technology for the localization of peripheral lung nodules by injection of marking agent or deployment of fiducial to the lesion through the endobronchial route causing much lower marking agent diffusion and artefacts. Recently, the combination of hybrid OR and ENB for lung nodule localization and marking has further increased the accuracy and applicability of the technology. The article will be exploring the latest development of the above approaches to lung nodule localization, and discuss some of the techniques' advantages and flaws.
在诊断和术中定位方面，肺结节的管理可能具有挑战性，尤其是在微创电视辅助胸腔镜手术（VATS）方法中，而对于单孔VATS且手术入路受限的情况可能更困难。术中定位小病变的能力对于诊断性冰冻切片的切除活检以及指导亚肺叶切除尤为重要。一些辅助定位的常用技术包括术前经皮钩丝定位、向结节或相邻部位注射彩色染料或放射性染料标记，以便术中通过放射性计数器进行可视化或检测。2013年首次报道了使用杂交手术室（OR）进行肺结节的术中定位，称为影像引导VATS（iVATS）。随后，我们将iVATS的应用扩展到单孔VATS对小的或磨玻璃样病变进行肺叶切除。通过在手术台上进行锥形束CT扫描，可以对肺部病变进行实时准确的评估，这有助于定位过程。在杂交手术室中，手术前可经皮部署的其他类型的物理或彩色标记物可以增强触觉反馈和数字触诊的敏感性，并提供不透射线的病灶以供放射学确认。在过去十年中，电磁导航支气管镜（ENB）技术已发展成为一种有用的辅助技术，通过经支气管途径向病变部位注射标记剂或植入基准物来定位周围型肺结节，从而使标记剂扩散和伪影大大减少。最近，杂交手术室和ENB相结合用于肺结节定位和标记，进一步提高了该技术的准确性和适用性。本文将探讨上述肺结节定位方法的最新进展，并讨论一些技术的优点和缺陷。
