Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, 200040, China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
J Cardiothorac Surg. 2020 Oct 9;15(1):307. doi: 10.1186/s13019-020-01279-9.
Video assisted thoracoscopic surgery (VATS) can currently be used to diagnose and treat pulmonary nodules. However, intraoperative location of pulmonary nodules in VATS is challenging due to their small diameter and deep location in the pulmonary parenchyma. The purpose of this study was to report the clinical safety and effectiveness of CT-guided hook-wire for preoperative localization of malignant pulmonary nodules smaller than 1 cm in diameter.
From February 2017 to January 2018, we collected the data of 80 patients with malignant pulmonary nodules less than 1 cm in diameter who underwent CT-guided hook-wire preoperative localization and VATS surgery. The effectiveness of preoperative localization was evaluated based on surgical duration, success rate of VATS surgery, and localization-related complications.
The diameter of pulmonary nodules were 0.85 ± 0.17 mm with a distance to the pleural surface of 19.66 ± 14.10 mm. The length of the hook-wire in the lung parenchyma was 29.17 ± 13.14 mm and hook-wire dislodgement occurred in 2 patients. Complications included 27 cases of minor pneumothorax and 18 cases of mild parenchymal hemorrhage. A significant correlation was observed between the length of the hook-wire in the lung parenchyma and mild parenchymal hemorrhage (P = 0.044). The average time of hook-wire localization was 9.0 ± 2.6 min and the average operation time for VATS was 89.02 ± 23.35 min without conversion thoracotomy.
CT-guided hook-wire localization of the lesion during VATS resection is safe for malignant pulmonary nodules with diameter less than 1 cm.
电视辅助胸腔镜手术（VATS）目前可用于诊断和治疗肺结节。然而，由于肺结节的直径小且位于肺实质深处，术中定位肺结节具有挑战性。本研究旨在报告 CT 引导下钩线在直径小于 1cm 的恶性肺结节术前定位中的临床安全性和有效性。
从 2017 年 2 月至 2018 年 1 月，我们收集了 80 例直径小于 1cm 的恶性肺结节患者的资料，这些患者接受了 CT 引导下钩线术前定位和 VATS 手术。根据手术时间、VATS 手术成功率和定位相关并发症评估术前定位的有效性。
肺结节的直径为 0.85±0.17mm，距胸膜表面的距离为 19.66±14.10mm。肺实质内的钩线长度为 29.17±13.14mm，有 2 例发生钩线移位。并发症包括 27 例轻度气胸和 18 例轻度实质内出血。肺实质内钩线的长度与轻度实质内出血呈显著正相关（P=0.044）。钩线定位的平均时间为 9.0±2.6min，VATS 的平均手术时间为 89.02±23.35min，无需转换开胸手术。
VATS 切除术中 CT 引导下病变钩线定位对直径小于 1cm 的恶性肺结节是安全的。
