肺手术中原发性机械定位移位后的补救性定位

Remedial localization after dislodgement of primary mechanical localization in lung surgery.

作者信息

Wang Long, Zhang Xufeng, Li Mu, Kadeer Xiermaimaiti, Dai Chenyang, Shi Zhe, Chen Chang

机构信息

Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.

Department of Thoracic Surgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China.

出版信息

J Thorac Dis. 2017 May;9(5):1240-1246. doi: 10.21037/jtd.2017.04.61.

DOI:10.21037/jtd.2017.04.61

PMID:28616274

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5465127/

Abstract

BACKGROUND

Unhooking or displacement of hookwire or microcoil due to technical failures is rather common. We aim to establish a new technique for remedial localization in the case of displacement or unhooking of primary mechanical localization during lung surgery.

METHODS

From February 2014 to September 2015, 18 consecutive cases of intraoperative dislodgement during video-assisted thoracoscopic surgery (VATS) were enrolled. Nodule's projection on body surface was located by analyzing computed tomography (CT) images, and a needle was inserted into thoracic cavity through this point. The lung was then inflated, and a small burn was made where the needle tip touched the visceral plural. Wedge resections were subsequently performed for these impalpable small lesions.

RESULTS

Eighteen solitary pulmonary nodules (SPNs) from 18 patients were scheduled for VATS wedge resections in this series, including 6 (33.3%) hookwire localization and 12 (66.7%) microcoil localization. Fifteen (83.3%) of 18 nodules were pure ground glass opacity (pGGO) and 3 (16.7%) mixed ground glass opacity (mGGO). The mean diameter of SPNs was 7.7±3.6 mm. The mean distance from SPN to pleura was 12.2±10.9 mm. During remedial localization, 17 (94.4%) nodules were removed successfully by wedge resection, and segmentectomy was performed only in one case with failed outcome. Paraffin pathology showed 2 (11.1%) atypical adenomatous hyperplasia (AAH), 11 (61.1%) adenocarcinoma in situ (AIS), 4 (22.2%) minimally invasive adenocarcinoma (MIA), and 1 (5.6%) inflammatory disease.

CONCLUSIONS

This remedial localization technique is practical and reliable. It is a good backup plan in the case of dislodgement, and it can help prevent extended lung resection.

摘要

背景

由于技术故障导致钩丝或微线圈脱钩或移位相当常见。我们旨在建立一种新技术，用于在肺手术中初次机械定位发生移位或脱钩的情况下进行补救性定位。

方法

2014年2月至2015年9月，连续纳入18例电视辅助胸腔镜手术（VATS）术中移位的病例。通过分析计算机断层扫描（CT）图像确定结节在体表的投影，然后经此点将针插入胸腔。然后使肺膨胀，在针尖接触脏层胸膜处进行小面积烧灼。随后对这些无法触及的小病变进行楔形切除术。

结果

本系列中18例患者的18个孤立性肺结节（SPN）计划行VATS楔形切除术，其中6例（33.3%）采用钩丝定位，12例（66.7%）采用微线圈定位。18个结节中有15个（83.3%）为纯磨玻璃密度影（pGGO），3个（16.7%）为混合磨玻璃密度影（mGGO）。SPN的平均直径为7.7±3.6mm。SPN到胸膜的平均距离为12.2±10.9mm。在补救性定位过程中，17个（94.4%）结节通过楔形切除术成功切除，仅1例手术失败而行肺段切除术。石蜡病理显示2例（11.1%）非典型腺瘤样增生（AAH），11例（61.1%）原位腺癌（AIS），4例（22.2%）微浸润腺癌（MIA），1例（5.6%）为炎症性疾病。