Seitz Sigurd T, Schellerer Vera S, Schmid Axel, Metzler Markus, Besendörfer Manuel
1 Department of Paediatric Surgery, University Medical Center Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany.
2 Department of Radiology, University Medical Center Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany.
J Laparoendosc Adv Surg Tech A. 2019 May;29(5):688-693. doi: 10.1089/lap.2018.0184. Epub 2019 Apr 4.
In pediatric patients, thoracoscopic wedge-resection of pulmonary nodules is an established therapy. However, intraoperative localization of small lesions is still challenging. Purpose of this study was to evaluate the efficacy of preoperative computed tomography (CT)-guided wire-marking of small lung nodules. Between 2012 and 2017 a total of six cases receiving thoracoscopic resection of CT-marked lung nodules were analyzed. The nodules were preoperatively tagged by a wire, which was attached to the thoracic wall by sterile dressing. Characteristics of interest were stability of wire, complete resection, and prevention of open thoracotomy. Six procedures were performed on five patients, including four men and one woman. Median age at intervention was 16 years (range 11-19 years). All patients had a history of primary malignancies, including osteosarcoma ( = 4) and synovial sarcoma ( = 1). A total of 10 nodules were visualized in CT of which 9 were marked by wire. The median expected size of nodules was 6 mm (range 2-23 mm). Two patients had bilateral, two left-sided and two right-sided lung lesions. There was no wire slippage. In five procedures wedge resection was possible; one case needed a near total lobe resection. In one case a mini-thoracotomy at port insertion site was performed to extract the specimen. There was no conversion to thoracotomy. Histopathology showed R0 resection in all patients. Malignancy was found in all specimens. In one patient postoperative hemorrhagic anemia necessitated transfusion. Preoperative wire-localization of small lung nodules is a safe and effective tool to enable thoracoscopic resection in children and to avoid thoracotomic interventions.
在儿科患者中，胸腔镜下肺结节楔形切除术是一种成熟的治疗方法。然而，术中对小病灶的定位仍然具有挑战性。本研究的目的是评估术前计算机断层扫描（CT）引导下对小肺结节进行金属丝标记的有效性。分析了2012年至2017年间共6例接受胸腔镜切除CT标记肺结节的病例。结节术前用金属丝标记，并通过无菌敷料固定于胸壁。关注的特征包括金属丝的稳定性、完整切除以及避免开胸手术。对5例患者进行了6次手术，其中男性4例，女性1例。干预时的中位年龄为16岁（范围11 - 19岁）。所有患者均有原发性恶性肿瘤病史，包括骨肉瘤（n = 4）和滑膜肉瘤（n = 1）。CT共显示10个结节，其中9个用金属丝标记。结节的中位预期大小为6 mm（范围2 - 23 mm）。2例患者为双侧肺病变，2例为左侧肺病变，2例为右侧肺病变。没有金属丝移位。5例手术可行楔形切除；1例需要近全肺叶切除。1例在端口插入部位进行了小切口开胸以取出标本。没有转为开胸手术。组织病理学显示所有患者均为R0切除。所有标本均发现恶性肿瘤。1例患者术后出血性贫血需要输血。术前对小肺结节进行金属丝定位是一种安全有效的工具，可使儿童能够进行胸腔镜切除并避免开胸干预。
