University of Pittsburgh Medical Center (UPMC), General Surgery Department, Pittsburg, PA.
UPMC Children's Hospital of Pittsburgh, Radiology Department, Pittsburgh, PA.
J Pediatr Surg. 2021 Jan;56(1):142-145. doi: 10.1016/j.jpedsurg.2020.09.021. Epub 2020 Oct 6.
BACKGROUND/PURPOSE: Thoracoscopic excision of pulmonary nodules is often required for diagnostic or therapeutic purposes, however subpleural and sub-centimeter nodules can be difficult to visualize. Various CT-guided localization techniques have been described, though there is minimal published pediatric data regarding the use of microcoils. We hypothesize that microcoil localization facilitates thoracoscopic resection of pulmonary nodules in children.
A multi-institutional retrospective review of children who underwent preoperative CT-guided localization of lung nodules was conducted from 2012 to 2019. A combination of methylene blue dye (MBD), wires, and microcoils were utilized for CT-guided localization. When microcoils were utilized, fluoroscopy assisted in lesion identification and resection.
Eighteen patients (mean age 13 years, range 2-21 years) underwent thoracoscopic resection of 24 preoperatively localized pulmonary nodules. Mean size and depth of the lesions were 5.5 mm and 10 mm, respectively. Microcoil placement was successful 95% of the time and assisted in lesion localization in 88% of cases. Wire localization was not a durable technique, as 3 of 5 wires became dislodged upon lung isolation.
Preoperative CT-guided localization with microcoils can assist in fluoroscopic-guided resection of pulmonary nodules in children. This technique avoids the pitfall of wire dislodgement, and provides surgeons an additional technique to localize sub-centimeter, subpleural nodules.
Retrospective Review.
Level III.
背景/目的：胸腔镜切除肺结节通常是出于诊断或治疗的目的，然而，对于胸膜下和亚厘米大小的结节，可能难以可视化。已经描述了各种 CT 引导下的定位技术，但关于微线圈在儿童中的应用，发表的相关数据很少。我们假设微线圈定位有助于儿童胸腔镜切除肺结节。
对 2012 年至 2019 年间接受术前 CT 引导下肺结节定位的儿童进行了多机构回顾性研究。使用亚甲蓝染料（MBD）、金属丝和微线圈的组合进行 CT 引导下的定位。当使用微线圈时，透视有助于识别和切除病变。
18 名患者（平均年龄 13 岁，范围 2-21 岁）接受了 24 个术前定位的肺结节的胸腔镜切除术。病变的平均大小和深度分别为 5.5mm 和 10mm。微线圈放置成功率为 95%，在 88%的病例中有助于病变定位。金属丝定位不是一种持久的技术，因为 5 根金属丝中有 3 根在肺隔离时脱落。
术前 CT 引导下微线圈定位可协助儿童肺结节的透视引导切除。该技术避免了金属丝移位的陷阱，并为外科医生提供了一种额外的技术来定位亚厘米、胸膜下的结节。
回顾性研究。
III 级。
