Almousa Omamah, Mayo John, English John, Finley Richard
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
Semin Thorac Cardiovasc Surg. 2019 Spring;31(1):129-134. doi: 10.1053/j.semtcvs.2018.09.006. Epub 2018 Sep 15.
The purpose of this study is to determine the utility of preoperative CT-guided microcoil localization followed by fluoroscopy guided video-assisted thoracoscopic resection in the diagnosis and management of small peripheral pulmonary nodules in patients with extra-thoracic malignancies. This study is a retrospective analysis of prospectively collected data between August 2003 and September 2013. Fifty patients with extra-thoracic malignancies underwent preoperative localization of small indeterminate pulmonary nodules using CT-guided microcoil localization. Nodules were then resected by video-assisted thoracoscopic resection wedge excision and intraoperative fluoroscopy guidance. Univariate and multivariate logistic regression analysis were conducted. Fifty patients with a history of 14 different extra-thoracic cancers (57% female, mean age 62 years) had 55 nodules resected (mean size = 12 mm, depth from visceral pleura = 22 mm). Histology of resected nodules showed metastasis (25 of 50 patients), benign (10 of 50), and (15 of 50) early stage primary lung cancer. Smokers were found 6 times more likely to present with primary lung cancer than metastasis (P < 0.009). CT-guided microcoil localization procedure was successful in all patients with a mean time of 31(10) minutes and allowed successful wedge resection in all cases with no major complications. The mean operative time and fluoroscopy time were 27(12) minutes and 3(5) minutes, respectively. Microcoil-guided thoracoscopic wedge resection was effective in achieving early definitive diagnosis and changed management in 50% of patients with presumed metastasis with minimal morbidity.
本研究的目的是确定术前CT引导下微线圈定位联合荧光透视引导下电视辅助胸腔镜切除术在胸外恶性肿瘤患者小周边型肺结节诊断和管理中的效用。本研究是对2003年8月至2013年9月前瞻性收集数据的回顾性分析。50例胸外恶性肿瘤患者采用CT引导下微线圈定位对小的不确定肺结节进行术前定位。然后通过电视辅助胸腔镜楔形切除术和术中荧光透视引导切除结节。进行了单因素和多因素逻辑回归分析。50例有14种不同胸外癌症病史的患者（57%为女性，平均年龄62岁）切除了55个结节（平均大小=12mm，距脏层胸膜深度=22mm）。切除结节的组织学检查显示转移（50例患者中的25例）、良性（50例中的10例）和（50例中的15例）早期原发性肺癌。发现吸烟者患原发性肺癌的可能性是转移的6倍（P<0.009）。CT引导下微线圈定位手术在所有患者中均成功，平均时间为31（10）分钟，所有病例均成功进行了楔形切除，无重大并发症。平均手术时间和荧光透视时间分别为27（12）分钟和3（5）分钟。微线圈引导下胸腔镜楔形切除术在实现早期明确诊断方面有效，并且在50%推测为转移的患者中改变了治疗方式，且发病率极低。
