用于CT引导下肺结节术前定位的钩丝与医用胶水的比较。

Comparison of hook-wire and medical glue for CT-guided preoperative localization of pulmonary nodules.

作者信息

Zhang Huijun, Li Ying, Chen Xiaofeng, He Zelai

机构信息

Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China.

Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Yangpu, Shanghai, China.

出版信息

Front Oncol. 2022 Aug 8;12:922573. doi: 10.3389/fonc.2022.922573. eCollection 2022.

DOI:10.3389/fonc.2022.922573

PMID:36003778

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9393881/

Abstract

BACKGROUND

Preoperative localization is challenging due to the small diameter of pulmonary nodules or their deep location in the lung parenchyma during VATS surgery. The purpose of this study was to compare the efficacy and safety of both hook-wire and medical glue for pre-operative localization of pulmonary nodules.

METHODS

In the current study, 158 patients were retrospectively analyzed (January 2019 and January 2020). The patients underwent hook-wire or medical glue for pre-operative localization of pulmonary nodules. Among them, 74 patients in the hook-wire group and 84 patients in the medical glue group underwent VATS anatomic segmentectomy or wedge resection after localization of pulmonary nodules. Pre-operative localization data from all patients were compiled. Moreover, the efficacy and safety of the two methods were evaluated according to localization success rates and localization-related complications.

RESULTS

The success rate of localization in the medical glue group was 100% while 97.3% in the hook-wire group. After localization of the pulmonary nodules, the incidence of minor pneumothorax in the medical glue group (11.9%) was lower than that in the hook-wire group (37.8%) (=0.01). The incidence of mild pulmonary parenchymal hemorrhage in the medical glue group (13.1%) was also lower than that in the hook-wire group (24.3%) (p=0.000). The mean time from the completion of localization to the start of surgery was also longer in the medical glue group than in the hook-wire group (p=0.000). The mean visual analog scale (VAS) scores after localization were higher in the hook-wire group than in the medical glue group (=0.02). In both groups, parenchymal hemorrhage was significantly associated with the needle length in hook-wire localization and the depth of the medical glue in the lung parenchyma ( = 0.009 and 0.001, respectively).

CONCLUSION

These two localization methods are safe and effective in pre-operative pulmonary nodule localization. The medical glue localization method had a lower risk of complications, a higher localization success rate, less pain after localization and more flexibility in the arrangement of operation time.

摘要

背景

在电视辅助胸腔镜手术（VATS）中，由于肺结节直径小或位于肺实质深部，术前定位具有挑战性。本研究的目的是比较钩丝和医用胶水在肺结节术前定位中的有效性和安全性。

方法

在本研究中，对158例患者（2019年1月至2020年1月）进行回顾性分析。这些患者接受了钩丝或医用胶水进行肺结节术前定位。其中，74例钩丝组患者和84例医用胶水组患者在肺结节定位后接受了VATS解剖性肺段切除术或楔形切除术。汇总了所有患者的术前定位数据。此外，根据定位成功率和定位相关并发症评估了两种方法的有效性和安全性。

结果

医用胶水组的定位成功率为100%，而钩丝组为97.3%。肺结节定位后，医用胶水组的轻度气胸发生率（11.9%）低于钩丝组（37.8%）（P=0.01）。医用胶水组的轻度肺实质出血发生率（13.1%）也低于钩丝组（24.3%）（P=0.000）。医用胶水组从定位完成到手术开始的平均时间也比钩丝组长（P=0.000）。定位后钩丝组的平均视觉模拟评分（VAS）高于医用胶水组（P=0.02）。在两组中，肺实质出血在钩丝定位中与针的长度以及在医用胶水中与肺实质内胶水的深度均显著相关（分别为P=0.009和P=0.001）。