Department of Thoracic Medicine and Surgery, Temple University Hospital, Lewis Katz School of Medicine, Philadelphia, Pa.
Department of Surgery, Temple University Hospital, Lewis Katz School of Medicine, Philadelphia, Pa.
J Thorac Cardiovasc Surg. 2017 Jun;153(6):1581-1590. doi: 10.1016/j.jtcvs.2016.12.044. Epub 2017 Feb 7.
Localizing small or deep pulmonary nodules or subsolid ground-glass opacities often is difficult during video-assisted thoracoscopic surgery (VATS) or robotic-assisted thoracoscopic surgery (RATS). This can result in larger resections or conversion to thoracotomy. The goal of this study is to evaluate the role of electromagnetic navigational bronchoscopic localization (ENBL) as a safe and accurate intraoperative method to localize small, deep, or subsolid nodules.
This is a single-institution, single-surgeon retrospective study of all patients (51) who underwent combined ENBL and resection of 54 nodules between May 2013 and August 2015. Localization was performed by intraoperative ENBL-guided transbronchial injection of a liquid marker. The liquid marker used was methylene blue, either alone or in addition to indocyanine green and Isovue. A fiduciary also was added in 2 cases. Immediately after localization, the patients underwent VATS for evaluation before proceeding with RATS for anatomical sublobar resection.
The mean preoperative largest nodule diameter on computed tomography scan was 13.3 mm (range, 4-44 mm). The mean distance from the surface of the lung to the middle of the nodule was 22 mm (range, 4-38 mm). Thirty-one nodules were solid (57.4%), whereas 23 were ground-glass opacities (42.6%). ENBL successfully localized the nodules for initial sublobar resection in 53 of 54 nodules (98.1%). Minimally invasive thoracoscopic surgery was performed successfully in 49 of 51 patients (96.1%), by RATS in 47 (92.2%), and VATS in 2 (3.9%). Two patients required conversion to thoracotomy secondary to extensive adhesions. Of the 54 nodules, final diagnosis was adenocarcinoma in 32 (59.2%), metastatic disease in 7 (13%), squamous cell carcinoma in 2 (3.7%), neuroendocrine tumor in 2 (3.7%), and benign in 11 (20.3%). There were no operative mortalities. Morbidities included acute renal insufficiency in 2 patients and prolonged air leak requiring a Heimlich valve in 3 patients. Mean length of stay was 3.9 days.
ENBL is a safe and accurate intraoperative modality for targeted sublobar resection of pulmonary nodules that are deemed difficult to localize.
在电视辅助胸腔镜手术（VATS）或机器人辅助胸腔镜手术（RATS）中，定位小的或深的肺结节或亚实性磨玻璃密度影通常很困难。这可能导致更大的切除或转为开胸手术。本研究的目的是评估电磁导航支气管镜定位（ENBL）作为一种安全、准确的术中方法，用于定位小的、深的或亚实性结节。
这是一项单中心、单外科医生回顾性研究，纳入了 2013 年 5 月至 2015 年 8 月期间接受 ENBL 联合切除 54 个结节的 51 例患者。通过术中 ENBL 引导的经支气管内注射液态标记物进行定位。使用的液态标记物为亚甲蓝，单独使用或与吲哚菁绿和 Isovue 联合使用。在 2 例中还添加了一个基准点。定位后，患者立即接受 VATS 评估，然后再进行 RATS 解剖性亚肺叶切除。
术前 CT 扫描最大结节直径的平均值为 13.3mm（范围 4-44mm）。结节距肺表面的平均距离为 22mm（范围 4-38mm）。31 个结节为实性（57.4%），23 个为磨玻璃密度影（42.6%）。ENBL 成功定位了 54 个结节中的 53 个（98.1%），用于初始亚肺叶切除。51 例患者中有 49 例（96.1%）成功行微创胸腔镜手术，其中 47 例（92.2%）行 RATS，2 例（3.9%）行 VATS。2 例患者因广泛粘连而转为开胸手术。54 个结节的最终诊断为腺癌 32 例（59.2%），转移瘤 7 例（13%），鳞状细胞癌 2 例（3.7%），神经内分泌肿瘤 2 例（3.7%），良性 11 例（20.3%）。无手术死亡病例。并发症包括 2 例急性肾功能不全和 3 例需要使用海姆立克阀的长时间漏气。平均住院时间为 3.9 天。
ENBL 是一种安全、准确的术中方法，可用于定位难以定位的肺部结节进行靶向亚肺叶切除。
