Zhao Guang, Sun Long, Geng Guojun, Liu Hongming, Li Ning, Liu Suhuan, Hao Bing, Yu Xiuyi, Jiang Jie
Department of Thoracic Surgery, the First Affiliated Hospital of Xiamen University, Xiamen 361003, China.
Department of Nuclear Medicine, the First Affiliated Hospital of Xiamen University, Xiamen 361003, China.
J Thorac Dis. 2017 Dec;9(12):5161-5170. doi: 10.21037/jtd.2017.11.58.
The aim of this study was to compare the effects of currently available preoperative localization methods, including semi-rigid single hook-wire, double-thorn hook-wire, and microcoil, in localizing the pulmonary nodules, thus to select the best technology to assist video-assisted thoracoscopic surgery (VATS) for small ground glass opacities (GGO).
Preoperative CT-guided localizing techniques including semi-rigid single hook-wire, double-thorn hook-wire and microcoil were used in re-aerated fresh swine lung for location experiments. The advantages and drawbacks of the three positioning technologies were compared, and then the most optimal technique was used in patients with GGO. Technical success and post-operative complications were used as primary endpoints.
All three localizing techniques were successfully performed in the re-aerated fresh swine lung. The median tractive force of semi-rigid single hook wire, double-thorn hook wire and microcoil were 6.5, 4.85 and 0.2 N, which measured by a spring dynamometer. The wound sizes in the superficial pleura, caused by unplugging the needles, were 2 mm in double-thorn hook wire, 1 mm in semi-rigid single hook and 1 mm in microcoil, respectively. In patients with GGOs, the semi-rigid hook wires localizations were successfully performed, without any complication that need to be intervened. Dislodgement was reported in one patient before VATS. No major complications related to the preoperative hook wire localization and VATS were observed.
We found from our localization experiments in the swine lung that, among the commonly used three localization methods, semi-rigid hook wire showed the best operability and practicability than double-thorn hook wire and microcoil. Preoperative localization of small pulmonary nodules with single semi-rigid hook wire system shows a high success rate, acceptable utility and especially low dislodgement in VATS.
本研究旨在比较目前可用的术前定位方法，包括半刚性单钩丝、双刺钩丝和微线圈，在肺结节定位中的效果，从而选择最佳技术辅助电视胸腔镜手术（VATS）治疗小磨玻璃结节（GGO）。
术前CT引导下的定位技术，包括半刚性单钩丝、双刺钩丝和微线圈，用于再通气的新鲜猪肺进行定位实验。比较三种定位技术的优缺点，然后将最佳技术应用于GGO患者。技术成功率和术后并发症作为主要终点。
所有三种定位技术均在再通气的新鲜猪肺中成功完成。用弹簧测力计测量，半刚性单钩丝、双刺钩丝和微线圈的中位牵引力分别为6.5、4.85和0.2N。拔针引起的浅表胸膜伤口大小，双刺钩丝为2mm，半刚性单钩为1mm，微线圈为1mm。在GGO患者中，半刚性钩丝定位成功完成，无任何需要干预的并发症。1例患者在VATS术前出现移位。未观察到与术前钩丝定位和VATS相关的重大并发症。
我们从猪肺定位实验中发现，在常用的三种定位方法中，半刚性钩丝比双刺钩丝和微线圈显示出更好的可操作性和实用性。单半刚性钩丝系统对小肺结节进行术前定位显示出高成功率、可接受的实用性，尤其是在VATS中移位率低。
