Kubo Yujiro, Watanabe Mototsugu, Choshi Haruki, Matsubara Kei, Shiotani Toshio, Kataoka Kazuhiko
Department of Thoracic Surgery, Iwakuni Clinical Center.
Department of Thoracic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.
Acta Med Okayama. 2021 Feb;75(1):55-61. doi: 10.18926/AMO/61435.
Small pulmonary lesions are often difficult to localize during thoracoscopic surgery. We describe a new com-puted tomography (CT)-guided pleural dye-marking method for small peripheral pulmonary lesions that does not involve a visceral pleural puncture. We used this technique for 23 lesions (22 patients) who underwent tho-racoscopic partial lung resection (Nov. 2016-Jan. 2018). With the patient in the lateral decubitus position, pre-operative CT-guided marking on the skin over the lesion was performed. During the surgery, we marked the visceral pleura with a skin marker directly or with an infant-size nutrition catheter with crystal violet at the tip through a venous indwelling needle inserted perpendicular to the skin marking. We localized and resected the lesions in all cases, without complications. The median nodule size measured histopathologically was 8 (4-20) mm overall, and 7 (0-20) mm of the solid part; the median distance from the visceral pleura to the nodule was 9 (1-33) mm. The median operation time was 67 (37-180) min. The median postoperative hospital stay was 3 (3-11) days. Our CT-guided pleural dye-marking method is useful and safe for the localization of small periph-eral pulmonary lesions in thoracoscopic partial lung resections.
小型肺部病变在胸腔镜手术中常常难以定位。我们描述了一种新的计算机断层扫描（CT）引导下的胸膜染料标记方法，用于不涉及脏层胸膜穿刺的小型周围型肺部病变。我们将该技术应用于23个病变（22例患者），这些患者接受了胸腔镜下肺部分切除术（2016年11月至2018年1月）。患者取侧卧位，在术前对病变上方皮肤进行CT引导下标记。手术过程中，我们直接用皮肤标记笔或通过垂直于皮肤标记处插入的静脉留置针，使用尖端带有结晶紫的婴儿尺寸营养导管对脏层胸膜进行标记。所有病例均成功定位并切除病变，无并发症发生。组织病理学测量的结节大小中位数总体为8（4 - 20）mm，实性部分为7（0 - 20）mm；脏层胸膜到结节的距离中位数为9（1 - 33）mm。手术时间中位数为67（37 - 180）分钟。术后住院时间中位数为3（3 - 11）天。我们的CT引导下胸膜染料标记方法对于胸腔镜下肺部分切除术中小型周围型肺部病变的定位是有用且安全的。
