Yao Fei, Yao Ju, Xu Lei, Wang Jian, Gao Libing, Wang Jian
Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Interact Cardiovasc Thorac Surg. 2019 Mar 1;28(3):387-393. doi: 10.1093/icvts/ivy277.
We report our initial technical experience with computed tomography (CT)-guided cyanoacrylate localization for resection of small pulmonary nodules (SPNs) and evaluate the feasibility of this technique.
Between June 2016 and December 2017, the diagnostic results of 55 consecutive patients (69 SPNs) who underwent preoperative CT-guided cyanoacrylate localization and consequent video-assisted thoracoscopic surgery (VATS) resection were retrospectively evaluated. Localization-related outcomes and perioperative outcomes were assessed.
Preoperative CT-guided cyanoacrylate localization was successfully performed in all the cases. Simultaneous localization was achieved in 8 (14.5%) patients with 2 nodules and 3 (5.5%) patients with 3 nodules. The mean size of the nodules was 8.5 ± 3.2 mm (range 5-20 mm), and their mean depth from the nearest pleural surface was 10.9 ± 7.7 mm (range 2-36 mm). The overall mean localization procedural time was 13.7 ± 7.2 min (range 6-37 min). Two localization-related complications (intrapulmonary focal haemorrhage and pneumothorax) were observed in 7 (12.7%) and 12 (21.8%) patients, respectively. All patients with complications were asymptomatic and received conservative treatment only. All SPNs were resected under VATS without any conversion to minithoracotomy or thoracotomy.
CT-guided cyanoacrylate localization is a feasible procedure to localize SPNs. The advantages of this technique include flexibility between insertion and excision, the ability to be applied to the whole lung field, a high success rate, patient comfort after insertion and a fast learning curve. Further studies are warranted to confirm the efficacy of this technique.
我们报告计算机断层扫描（CT）引导下氰基丙烯酸酯定位用于切除小肺结节（SPN）的初步技术经验，并评估该技术的可行性。
回顾性评估2016年6月至2017年12月期间连续55例患者（69个SPN）的诊断结果，这些患者接受了术前CT引导下氰基丙烯酸酯定位及随后的电视辅助胸腔镜手术（VATS）切除。评估了定位相关结果和围手术期结果。
所有病例均成功进行了术前CT引导下氰基丙烯酸酯定位。8例（14.5%）有2个结节的患者和3例（5.5%）有3个结节的患者实现了同时定位。结节的平均大小为8.5±3.2毫米（范围5 - 20毫米），其距最近胸膜表面的平均深度为10.9±7.7毫米（范围2 - 36毫米）。总体平均定位操作时间为13.7±7.2分钟（范围6 - 37分钟）。分别在7例（12.7%）和12例（21.8%）患者中观察到2种与定位相关的并发症（肺内局灶性出血和气胸）。所有有并发症的患者均无症状，仅接受了保守治疗。所有SPN均在VATS下切除，未转为小切口开胸或开胸手术。
CT引导下氰基丙烯酸酯定位是定位SPN的可行方法。该技术的优点包括插入和切除之间的灵活性、适用于整个肺野的能力、高成功率、插入后患者舒适度高以及学习曲线短。有必要进行进一步研究以证实该技术的疗效。
