Yanagiya Masahiro, Matsumoto Jun, Yamaguchi Hirokazu, Nakajima Jun, Sato Masaaki
Department of General Thoracic Surgery, NTT Medical Center Tokyo, Tokyo, Japan.
Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
J Thorac Dis. 2019 Jan;11(1):162-170. doi: 10.21037/jtd.2018.12.60.
Virtual-assisted lung mapping (VAL-MAP) is a preoperative multi-spot bronchoscopic dye-marking technique. Marking failure reportedly occurs in approximately 10% of marks. The aim of the present study was to investigate whether the patient position during dye injection in VAL-MAP affected the quality of markings.
This study was a retrospective review of patients with barely palpable pulmonary nodules who underwent VAL-MAP at a single institution between December 2016 and September 2017. Easily visible markings without bulla formation were defined as "appropriate", while other markings were defined as "inappropriate". Patients were divided in accordance with the position during dye injection into the supine position group (n=6) and the lateral position group (n=8). The two groups were compared regarding the appropriate markings rate. The Fisher exact test and logistic regression model were used for statistical analyses.
Fourteen patients with 17 nodules underwent VAL-MAP with a total of 48 markings (3.4±0.9 markings per patient). Of these, 21 markings were performed in supine position, whereas 27 were performed in lateral position. There were no significant differences between the two groups in lesion size, depth, and characteristics. Almost all of the performed procedures were thoracoscopic wedge resections (94%), while one procedure was thoracoscopic left upper division segmentectomy. The appropriate markings rate was significantly greater in the lateral position group than in the supine position group (88% 57%, P=0.02). Among the markings located in dorsal and ventral lung segments, the appropriate markings rate in the lateral position group tended to be greater than that in the supine position group (89% 59%, P=0.06). Multivariate logistic regression analysis revealed that the lateral position was independently associated with appropriate markings (P=0.014).
The lateral position may enable the creation of better quality markings in VAL-MAP.
虚拟辅助肺定位（VAL-MAP）是一种术前多点支气管镜下染料标记技术。据报道，标记失败率约为10%。本研究的目的是调查VAL-MAP染料注射过程中患者的体位是否会影响标记质量。
本研究是对2016年12月至2017年9月在单一机构接受VAL-MAP的肺部结节难以触及的患者进行的回顾性研究。将无气泡形成的清晰可见标记定义为“合适”，而其他标记定义为“不合适”。根据染料注射时的体位将患者分为仰卧位组（n=6）和侧卧位组（n=8）。比较两组的合适标记率。采用Fisher精确检验和逻辑回归模型进行统计分析。
14例患者的17个结节接受了VAL-MAP，共进行了48次标记（每位患者3.4±0.9次标记）。其中，21次标记在仰卧位进行，27次在侧卧位进行。两组在病变大小、深度和特征方面无显著差异。几乎所有手术均为胸腔镜楔形切除术（94%），1例为胸腔镜左上叶段切除术。侧卧位组的合适标记率显著高于仰卧位组（88%对57%，P=0.02）。在位于肺背段和腹段的标记中，侧卧位组的合适标记率往往高于仰卧位组（89%对59%，P=0.06）。多因素逻辑回归分析显示，侧卧位与合适标记独立相关（P=0.014）。
侧卧位可能有助于在VAL-MAP中创建质量更好的标记。
