Gruber-Rouh T, Naguib N N N, Beeres M, Kleine P, Vogl T J, Jacobi V, Alsubhi M, Nour-Eldin N A
Institute for Diagnostic and Interventional Radiology, University Hospital, Theodor-Stern-Kai St.7, 60590 Frankfurt am Main, Germany.
Institute for Diagnostic and Interventional Radiology, University Hospital, Theodor-Stern-Kai St.7, 60590 Frankfurt am Main, Germany; Department of Diagnostic and Interventional Radiology, Alexandria University Hospital, Alexandria, Egypt.
Clin Radiol. 2017 Oct;72(10):898.e7-898.e11. doi: 10.1016/j.crad.2017.05.015. Epub 2017 Jun 12.
To assess the feasibility, safety, and efficacy of computed tomography (CT)-guided pulmonary nodule localisation using a hooked guide wire before video-assisted thoracoscopic surgery (VATS).
The study included 79 patients with a history of malignancies outside the lung associated with pulmonary nodules. Mean lesion size was 0.7 cm (range 0.5-1.8 cm) and the mean lesion distance to the pleural surface was 1.5 cm (range 0.2-5 cm). All lesions (n=82) were marked with a 22-G hook wire. The technique was designed to insert the tip of the hook wire within or maximally 1 cm from the edge of the lesion. The Mann-Whitney U-test was used for univariate analyses and Fisher's exact test for categorical values.
The hooked guide wire was positioned successfully in all 82 pulmonary nodules within mean time of 9 minutes (8-20 minutes, SD: 2.5 minutes). The procedure time was inversely proportional to the size of the lesion (Spearman correlation factor 0.7). Minimal pneumothoraces were observed in five patients (7.6%). Pneumothorax was not correlated to the histopathology of the pulmonary nodules (p>0.09). Focal perilesional pulmonary haemorrhage developed in four patients (5%). Both haemorrhage and pneumothorax were significantly correlated to lesions <10 mm (p=0.02 and 0.01 respectively). The volume of resected lung tissue was significantly correlated to lesions of increased distance from the pleural surface ≥2.5 cm in comparison to lesions of <2.5 cm from the pleural surface.
CT-guided pulmonary nodule localisation prior to VATS could enable safe, accurate surgical guidance for the localisation of small pulmonary nodules.
评估在电视辅助胸腔镜手术（VATS）前使用带钩导丝进行计算机断层扫描（CT）引导下肺结节定位的可行性、安全性和有效性。
本研究纳入79例有肺外恶性肿瘤病史且伴有肺结节的患者。病变平均大小为0.7厘米（范围0.5 - 1.8厘米），病变距胸膜表面的平均距离为1.5厘米（范围0.2 - 5厘米）。所有82个病变均用22G带钩导丝标记。该技术旨在将带钩导丝尖端插入病变边缘内或距病变边缘最大1厘米处。采用Mann-Whitney U检验进行单因素分析，采用Fisher精确检验分析分类变量。
82个肺结节均成功定位带钩导丝，平均时间为9分钟（8 - 20分钟，标准差：2.5分钟）。操作时间与病变大小成反比（Spearman相关系数0.7）。5例患者（7.6%）出现少量气胸。气胸与肺结节的组织病理学无关（p>0.09）。4例患者（5%）出现局灶性病变周围肺出血。出血和气胸均与<10毫米的病变显著相关（分别为p = 0.02和0.01）。与距胸膜表面<2.5厘米的病变相比，切除的肺组织体积与距胸膜表面≥2.5厘米的病变距离增加显著相关。
VATS前CT引导下肺结节定位可为小肺结节的定位提供安全、准确的手术指导。
