Imperatori Andrea, Fontana Federico, Dominioni Lorenzo, Piacentino Filippo, Macchi Edoardo, Castiglioni Massimo, Desio Matteo, Cattoni Maria, Nardecchia Elisa, Rotolo Nicola
Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy.
Interact Cardiovasc Thorac Surg. 2019 Jul 1;29(1):137-143. doi: 10.1093/icvts/ivz030.
Computed tomography (CT)-guided hydrogel plug deployment was recently proposed for lung nodule preoperative localization and simultaneous prevention of pneumothorax. We analysed our initial experience with CT-guided hydrogel plug localization of lung nodules in patients undergoing video-assisted thoracoscopic (VATS) resection.
We retrospectively evaluated the medical notes from 27 consecutive patients (mean age 68 ± 11 SD years; men 74%) undergoing VATS lung wedge resection for biopsy or definitive treatment of 28 small pulmonary nodules (malignant 82%) at a single institution between October 2017 and July 2018. Difficult intraoperative nodule localization was anticipated with a lesion <10 mm, a depth from pleura:size ratio >1, ground-glass opacity or the judgement of the operating surgeon. All lesions were preoperatively marked by deployment of a CT-guided hydrogel plug. Study end points were frequency of postlocalization pneumothorax; feasibility of delayed surgery; rate of localization of intraoperative nodule and rate of successful VATS resection.
The mean sizes of the solid nodules (n = 24) and of the ground-glass opacities (n = 4) were, respectively, 10.4 ± 3.4 mm and 16.0 ± 6.2 mm. One (4%) hydrogel plug marking procedure caused a clinically relevant pneumothorax. Nodule resection was scheduled flexibly as required by patient management/operating room scheduling: same day (11 nodules) or delayed [median 6 days (range 1-60 days)]; (17 nodules). All nodules were localized intraoperatively: 25 (89%) by hydrogel plug; 3 (11%) by palpation and pleural puncture hole visible after plug displacement. All nodules were completely excised by VATS, without complications.
CT-guided hydrogel plug marking was valuable for VATS localization and resection of challenging lung nodules. The plug minimized clinically relevant pneumothoraxes and allowed flexible surgical schedules.
计算机断层扫描（CT）引导下的水凝胶塞置入术最近被用于肺结节术前定位及同时预防气胸。我们分析了在接受电视辅助胸腔镜（VATS）切除的患者中，使用CT引导下水凝胶塞对肺结节进行定位的初步经验。
我们回顾性评估了2017年10月至2018年7月期间在单一机构接受VATS肺楔形切除术以活检或明确治疗28个小肺结节（82%为恶性）的27例连续患者（平均年龄68±11标准差岁；男性占74%）的病历。若病变<10mm、胸膜深度与大小比值>1、磨玻璃样混浊或手术医生判断，则预期术中结节定位困难。所有病变均在术前通过CT引导下置入水凝胶塞进行标记。研究终点包括定位后气胸的发生率；延迟手术的可行性；术中结节定位率及VATS切除成功率。
实性结节（n=24）和磨玻璃样混浊（n=4）的平均大小分别为10.4±3.4mm和16.0±6.2mm。1例（4%）水凝胶塞标记操作导致了具有临床意义的气胸。根据患者管理/手术室安排，结节切除可灵活安排：当天（11个结节）或延迟[中位时间6天（范围1 - 60天）]；（17个结节）。所有结节均在术中被定位：25个（89%）通过水凝胶塞定位；3个（11%）通过触诊和水凝胶塞移位后可见的胸膜穿刺孔定位。所有结节均通过VATS完全切除，无并发症。
CT引导下水凝胶塞标记对于VATS定位和切除具有挑战性的肺结节很有价值。该水凝胶塞将具有临床意义的气胸降至最低，并允许灵活安排手术时间。
