Patella Miriam, Bartolucci Dario Alberto, Mongelli Francesco, Cartolari Roberto, Minerva Eleonora Maddalena, Inderbitzi Rolf, Cafarotti Stefano
Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland.
Service of Radiology, San Giovanni Hospital, Bellinzona, Switzerland.
J Thorac Dis. 2019 Dec;11(12):5237-5246. doi: 10.21037/jtd.2019.11.74.
In the last years, a large number of techniques and devices for localizing small pulmonary nodules prior to resection have been developed with the aim of facilitating minimally invasive surgery (VATS). However, each device presents pros and cons and there is no unanimous consensus. We report our experience with an uncommon wire system with spiral shape for percutaneous marking.
We recorded 102 consecutive CT-guided spiral wire localizations in our Institution, and we evaluated the efficacy of the method according to 4 success rates (SR): (I) successful targeting rate (SR-1): number of successful targeting procedures/number of all localizations; (II) successful localization in operative field (SR-2): (number of successful targeting procedures -number of dislodgements in operative field)/number of all localizations; (III) successful VATS rate (SR-3): number of successful VATS procedures/(number of localizations-number of thoracotomies not due to wire dislocation); (IV) successful curative rate (SR-4): number of neoplastic nodules resected with curative intent with free margins (R0) on definitive tissue diagnosis/number of neoplastic nodules resected with curative intent. Complications rate was recorded as well.
SR-1: 100%, SR-2: 97.1%, SR-3: 100%, SR-4: 100%. Asymptomatic pneumothorax and minimal parenchymal hemorrhage were observed in 5 (4.9%) and 19 (18.6%) cases, respectively.
Spiral wire localization showed very good results in terms of feasibility, stability in operative field and contributed to effective use of VATS during wedge resection performed for malignant nodules. In the era of widespread radiological investigations (as it is happening in lung cancer screening) and evolutions in cancer treatments, this appears to be clinically relevant.
在过去几年中，为便于进行微创手术（电视辅助胸腔镜手术，VATS），已开发出大量用于在切除前定位小肺结节的技术和设备。然而，每种设备都有其优缺点，且尚未达成一致共识。我们报告了使用一种罕见的螺旋形金属丝系统进行经皮标记的经验。
我们记录了在本机构连续进行的102例CT引导下螺旋金属丝定位病例，并根据4种成功率（SR）评估该方法的有效性：（I）成功靶向率（SR-1）：成功靶向程序数/所有定位数；（II）手术视野内成功定位率（SR-2）：（成功靶向程序数-手术视野内移位数）/所有定位数；（III）成功VATS率（SR-3）：成功VATS程序数/（定位数-非因金属丝移位导致的开胸数）；（IV）成功治愈率（SR-4）：经最终组织诊断切缘阴性（R0）的根治性切除肿瘤结节数/根治性切除肿瘤结节数。同时记录并发症发生率。
SR-1：100%，SR-2：97.1%，SR-3：100%，SR-4：100%。分别有5例（4.9%）出现无症状气胸，19例（18.6%）出现轻微实质内出血。
螺旋金属丝定位在可行性、手术视野稳定性方面显示出非常好的效果，并有助于在对恶性结节进行楔形切除时有效使用VATS。在广泛开展放射学检查的时代（如肺癌筛查中所发生的那样）以及癌症治疗的发展过程中，这似乎具有临床相关性。
