Sekimura Atsushi, Funasaki Aika, Iwai Shun, Motono Nozomu, Usuda Katsuo, Uramoto Hidetaka
Department of Thoracic Surgery, Kanazawa Medical University, Daigaku, Uchinada, Ishikawa, Japan.
J Thorac Dis. 2019 Jul;11(7):2745-2753. doi: 10.21037/jtd.2019.06.68.
In recent years, small lung nodules have been detected by computed tomography (CT). Wedge resection of small pulmonary nodules is widely performed with video-assisted thoracoscopic surgery (VATS). However, it is extremely difficult to identify the position of a small tumor by palpation using a small access port. Therefore, this study aimed to describe a newly devised method of marking the location of the tumor.
In 51 cases, we marked the skin directly above the tumor under CT guidance before surgery and then placed a pleural marker with dye on the parietal pleura directly below the region marked on the skin using a catheter needle. To evaluate the accuracy of the marking, the distance between the center of the marking and the visceral pleura closest to the tumor was measured.
The mean distance between the center of marking and the visceral pleura closest to the tumor was 12.4 mm. In 47 cases (92%), the tumor was within 30 mm from the marking site. The surgical approach was VATS in 44 cases. In one case, conversion to open surgery was required for palpation of the tumor. All tumors were resected completely. No morbidity was observed during or after surgery.
Our CT-guided cutaneous marking and pleural marking method was able to identify the location of the tumor with high accuracy, making palpation easier during VATS. This new procedure should be implemented in the clinical setting given its ease of application, safety, and accuracy.
近年来，计算机断层扫描（CT）检测出了小的肺结节。小肺结节的楔形切除术广泛通过电视辅助胸腔镜手术（VATS）进行。然而，使用小切口端口通过触诊来确定小肿瘤的位置极其困难。因此，本研究旨在描述一种新设计的标记肿瘤位置的方法。
在51例病例中，我们在手术前在CT引导下直接标记肿瘤上方的皮肤，然后使用导管针在皮肤标记区域正下方的壁层胸膜上放置带染料的胸膜标记物。为了评估标记的准确性，测量标记中心与最接近肿瘤的脏层胸膜之间的距离。
标记中心与最接近肿瘤的脏层胸膜之间的平均距离为12.4毫米。在47例（92%）病例中，肿瘤距离标记部位在30毫米以内。44例采用VATS手术入路。1例因肿瘤触诊需要转为开放手术。所有肿瘤均完全切除。手术期间或术后未观察到并发症。
我们的CT引导下皮肤标记和胸膜标记方法能够高精度地确定肿瘤位置，使VATS手术期间的触诊更容易。鉴于其易于应用、安全性和准确性，这一新程序应在临床中实施。
