Zhong Yan, Xu Xiao-Quan, Pan Xiang-Long, Zhang Wei, Xu Hai, Yuan Mei, Kong Ling-Yan, Pu Xue-Hui, Chen Liang, Yu Tong-Fu
Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China.
Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Cardiovasc Intervent Radiol. 2017 Sep;40(9):1408-1414. doi: 10.1007/s00270-017-1631-3. Epub 2017 Mar 29.
To evaluate the safety and efficacy of the hook wire system in the simultaneous localizations for multiple pulmonary nodules (PNs) before video-assisted thoracoscopic surgery (VATS), and to clarify the risk factors for pneumothorax associated with the localization procedure.
Between January 2010 and February 2016, 67 patients (147 nodules, Group A) underwent simultaneous localizations for multiple PNs using a hook wire system. The demographic, localization procedure-related information and the occurrence rate of pneumothorax were assessed and compared with a control group (349 patients, 349 nodules, Group B). Multivariate logistic regression analyses were used to determine the risk factors for pneumothorax during the localization procedure.
All the 147 nodules were successfully localized. Four (2.7%) hook wires dislodged before VATS procedure, but all these four lesions were successfully resected according to the insertion route of hook wire. Pathological diagnoses were acquired for all 147 nodules. Compared with Group B, Group A demonstrated significantly longer procedure time (p < 0.001) and higher occurrence rate of pneumothorax (p = 0.019). Multivariate logistic regression analysis indicated that position change during localization procedure (OR 2.675, p = 0.021) and the nodules located in the ipsilateral lung (OR 9.404, p < 0.001) were independent risk factors for pneumothorax.
Simultaneous localizations for multiple PNs using a hook wire system before VATS procedure were safe and effective. Compared with localization for single PN, simultaneous localizations for multiple PNs were prone to the occurrence of pneumothorax. Position change during localization procedure and the nodules located in the ipsilateral lung were independent risk factors for pneumothorax.
评估在电视辅助胸腔镜手术（VATS）前，钩丝系统对多个肺结节（PNs）进行同步定位的安全性和有效性，并明确与定位过程相关的气胸危险因素。
2010年1月至2016年2月期间，67例患者（147个结节，A组）使用钩丝系统对多个PNs进行同步定位。评估人口统计学、定位过程相关信息和气胸发生率，并与对照组（349例患者，349个结节，B组）进行比较。采用多因素逻辑回归分析确定定位过程中气胸的危险因素。
147个结节均成功定位。4根（2.7%）钩丝在VATS手术前移位，但这4个病变均根据钩丝插入路径成功切除。所有147个结节均获得病理诊断。与B组相比，A组手术时间明显更长（p < 0.001），气胸发生率更高（p = 0.019）。多因素逻辑回归分析表明，定位过程中的位置变化（OR 2.675，p = 0.021）和位于同侧肺的结节（OR 9.404，p < 0.001）是气胸的独立危险因素。
在VATS手术前使用钩丝系统对多个PNs进行同步定位是安全有效的。与单个PN定位相比，多个PNs同步定位更容易发生气胸。定位过程中的位置变化和位于同侧肺的结节是气胸的独立危险因素。
