Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan.
Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.
J Formos Med Assoc. 2019 Jun;118(6):979-985. doi: 10.1016/j.jfma.2019.02.005. Epub 2019 Mar 9.
BACKGROUND/PURPOSE: In video-assisted thoracic surgery (VATS) resection of small lung nodules, preoperative dye marking around the visceral pleura provides surface localization to help initiate resection, while implantation of a fiducial marker such as a microcoil can provide inner localization to aid nodule resection under fluoroscopic guidance. We aimed to determine whether dual localization with microcoil placement and dye marking is safe and useful for guiding the resection of small deep-seated lung nodules.
We retrospectively evaluated data pertaining to 39 consecutive patients (40 nodules) managed between January 2016 and December 2017 in our hospital. Dual localization with patent blue V dye and microcoil was performed preoperatively because the pulmonary nodules were expected to be difficult to visualize or palpate intraoperatively. The patients underwent computed tomography-guided dual localization in a single puncture and were then transferred to the operation room. Intraoperative fluoroscopy was used to ensure that the lung tissue resected included the microcoil.
All 40 lesions were successfully resected using the dual localization technique followed by fluoroscopy-assisted thoracoscopic surgery. The median lesion diameter and depth were 0.9 and 1.7 cm, respectively, while the median margin/diameter ratio in the first resected specimen was 1.25. One patient had failure of localization due to partial release of the microcoil into the chest wall. Localization-related pneumothorax was detected in six of 39 patients (15.4%) and was always self-limited.
Dual localization with microcoil placement and dye marking is safe and supports successful VATS resection of small deep-seated lung nodules.
背景/目的：在电视辅助胸腔镜手术（VATS）切除肺部小结节时，在脏层胸膜周围进行术前染料标记可提供表面定位，有助于起始切除，而植入微线圈等基准标记物则可提供内定位，有助于在透视引导下切除结节。我们旨在确定微线圈放置和染料标记的双重定位是否安全且有助于指导小而深在的肺结节切除。
我们回顾性评估了 2016 年 1 月至 2017 年 12 月期间在我院接受治疗的 39 例连续患者（40 个结节）的数据。由于预计术中难以观察或触诊肺部结节，因此在术前进行了微线圈和专利蓝 V 染料的双重定位。患者在 CT 引导下进行单次穿刺双重定位，然后转入手术室。术中透视用于确保切除的肺组织包含微线圈。
所有 40 个病灶均成功使用双重定位技术联合透视辅助胸腔镜手术切除。病灶的中位直径和深度分别为 0.9cm 和 1.7cm，首次切除标本的中位切缘/直径比为 1.25。1 例患者因微线圈部分释放到胸壁而导致定位失败。39 例患者中有 6 例（15.4%）出现与定位相关的气胸，且均为自限性。
微线圈放置和染料标记的双重定位安全可靠，支持成功进行 VATS 切除小而深在的肺部结节。
