Kleedehn Mark, Kim David H, Lee Fred T, Lubner Meghan G, Robbins Jessica B, Ziemlewicz Timothy J, Hinshaw J Louis
1 Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, E3/311, Madison, WI 53792.
2 Department of Medical Physics, University of Wisconsin-Madison, Madison, WI.
AJR Am J Roentgenol. 2016 Dec;207(6):1334-1339. doi: 10.2214/AJR.16.16272. Epub 2016 Sep 22.
Small pulmonary nodules are often difficult to identify during thoracoscopic resection, and preoperative CT-guided localization performed using either hookwire placement or methylene blue injection can be helpful. The purpose of this study is to compare the localization success and complication rates of these two techniques.
One hundred two consecutive patients who underwent a total of 109 localization procedures performed with CT fluoroscopic guidance were analyzed. The procedures included 52 hookwire insertions and 57 methylene blue injections. The localization success and complication rates associated with the two groups were compared.
All nodules in both groups were identified intraoperatively, except for those in two patients in the hookwire group who did not proceed to undergo same-day surgery, including one with a massive systemic air embolus that resulted in death. Hookwires were dislodged in seven of 52 cases (13%), but the surgeons were still able to locate the nodules through visualization of the parenchymal puncture sites. The total number of complications was higher in the hookwire insertion group than in the methylene blue injection group, but this trend was not statistically significant, with all types of complications occurring in 28 cases (54%) versus 26 cases (46%) (p = 0.45), major complications noted in four cases (8%) versus one case (2%) (p = 0.19), pneumothorax observed in 20 cases (38%) versus 14 cases (25%) (p = 0.15), and perilesional hemorrhage occurring in six cases (12%) versus two cases (4%) (p = 0.15), respectively.
The present study suggests that methylene blue injection and hookwire insertion are statistically equivalent for preoperative pulmonary nodule localization; however, seven of 52 hookwires dislodged, and trends toward more frequent and severe complications were noted in the hookwire insertion group.
在胸腔镜切除术中，小的肺结节常常难以识别，术前使用钩丝置入或亚甲蓝注射进行CT引导定位可能会有所帮助。本研究的目的是比较这两种技术的定位成功率和并发症发生率。
分析了102例连续接受CT透视引导下共109次定位操作的患者。这些操作包括52次钩丝插入和57次亚甲蓝注射。比较了两组的定位成功率和并发症发生率。
两组中的所有结节均在术中被识别，除了钩丝组中有两名患者未进行当日手术，其中一名发生大量系统性空气栓塞导致死亡。52例中有7例（13%）钩丝移位，但外科医生仍能通过观察实质穿刺部位来定位结节。钩丝插入组的并发症总数高于亚甲蓝注射组，但这种趋势无统计学意义，所有类型并发症分别发生在28例（54%）和26例（46%）（p = 0.45），主要并发症分别为4例（8%）和1例（2%）（p = 0.19），气胸分别为20例（38%）和14例（25%）（p = 0.15），病灶周围出血分别为6例（12%）和2例（4%）（p = 0.15）。
本研究表明，亚甲蓝注射和钩丝插入在术前肺结节定位方面在统计学上是等效的；然而，52根钩丝中有7根移位，且钩丝插入组有并发症更频繁和更严重的趋势。
