Fumimoto Satoshi, Sato Kiyoshi, Koyama Mitsuhiro, Yamamoto Kazuhiro, Narumi Yoshifumi, Hanaoka Nobuharu, Katsumata Takahiro
Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
Department of Radiology, Osaka Medical College, Takatsuki, Osaka, Japan.
J Thorac Dis. 2018 May;10(5):2940-2947. doi: 10.21037/jtd.2018.05.28.
The development of diagnostic technology has led to detection of an increasing number of small pulmonary nodules (SPNs), which can be difficult to locate intraoperatively. Here, we report our experience performing single-stage lipiodol localization and surgical resection in a hybrid operating room (OR).
Between June 2016 and August 2017, 30 patients with 32 SPNs underwent sliding gantry-based multidetector computed tomography (MDCT)-guided lipiodol marking followed by video-assisted thoracoscopic surgery (VATS) in a hybrid OR. After induction of general anesthesia, all nodules were marked with 0.2 mL lipiodol under MDCT fluoroscopic guidance, followed by immediate VATS.
The mean SPN diameter and distance from the pleural surface were 10.7±4.5 mm (range, 5.0-21.0 mm) and 18.0±9.0 mm (range, 2.8-32.0 mm) respectively. The MDCT-guided localization procedure required 15.8±6.0 min (range, 8.0-32.0 min). All the nodules were marked with lipiodol and detected during fluoroscopy as a clear spot. The median deviation between the radio-opaque nodule and the target nodule was 7.8±3.6 mm (range, 3.0-20.0 mm). In two cases, MDCT scans performed after completion of marking revealed mild pneumothorax, which did not need further intervention. VATS resection was converted to thoracotomy in two patients because of strong pleural adhesions and intraoperative bleeding from the pulmonary vein. No other complications occurred during the combined approach, and there was no intra- or post-operative mortality or morbidity.
These results suggest that a combined approach using MDCT-guided lipiodol marking followed by VATS is feasible and has acceptable accuracy in resection of SPNs.
诊断技术的发展使得越来越多的小肺结节（SPN）被检测出来，这些结节在术中可能难以定位。在此，我们报告我们在杂交手术室（OR）中进行单阶段碘油定位和手术切除的经验。
2016年6月至2017年8月期间，30例患有32个SPN的患者在杂交手术室接受了基于滑动龙门架的多探测器计算机断层扫描（MDCT）引导下的碘油标记，随后进行了电视辅助胸腔镜手术（VATS）。全身麻醉诱导后，在MDCT透视引导下用0.2 mL碘油对所有结节进行标记，随后立即进行VATS。
SPN的平均直径和距胸膜表面的距离分别为10.7±4.5 mm（范围5.0 - 21.0 mm）和18.0±9.0 mm（范围2.8 - 32.0 mm）。MDCT引导下的定位过程需要15.8±6.0分钟（范围8.0 - 32.0分钟）。所有结节均用碘油标记，并在透视下作为清晰的亮点被检测到。不透射线结节与目标结节之间的中位偏差为7.8±3.6 mm（范围3.0 - 20.0 mm）。在两例病例中，标记完成后进行的MDCT扫描显示有轻度气胸，无需进一步干预。两名患者因胸膜粘连严重和肺静脉术中出血，VATS切除转为开胸手术。联合手术过程中未发生其他并发症，术中及术后均无死亡或发病情况。
这些结果表明，采用MDCT引导下碘油标记随后进行VATS的联合方法在SPN切除中是可行的，且具有可接受的准确性。
