Saito Yuichi, Watanabe Tomohiro, Kanamoto Yasuyuki, Asami Momoko, Yokote Fumi, Dejima Hitoshi, Morooka Hiroaki, Ibi Takayuki, Yamauchi Yoshikane, Takahashi Nobumasa, Ikeya Tomohiko, Sakao Yukinori, Kawamura Masafumi
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Department of Thoracic Surgery, Saitama Cardiovascular and Respiratory Center, Saitama, Japan.
J Thorac Dis. 2022 Aug;14(8):2845-2854. doi: 10.21037/jtd-22-190.
Intraoperative identification of small pulmonary nodules has been an important technical issue. We aimed to develop a new localization method which is much safer and simple procedure compared with conventional methods.
This was a retrospective study including patients with resected peripheral pulmonary nodules between November 2017 and April 2021 at Teikyo University School of Medicine, and Saitama Cardiovascular and Respiratory Center. All surgical procedure was wedge resection, and the tumor size was equal to or less than 20 mm which were detected by cone-beam computed tomography (CBCT; Philips Allura Xper FD 20, Philips). Some metal clips were put on several places of visceral pleura, where the target lesion was sandwiched by marking clips (sandwich marking technique). CBCT detected both the target lesion and metal clips, and video-assisted thoracoscopic surgery (VATS) was performed. Radiological and pathological findings were analyzed, and the correlation coefficient of tumor size was examined among pre-, intra-, and post-operative tumor sizes.
The average age of 90 patients was 65.2 years, and 47 were male (52.2%). All procedure was wedge resection including twelve bi-wedge resections, and one hundred nine peripheral pulmonary lesions were obtained by sandwich marking technique. The detection rate was 100%, and there was no marking-related complication.
All small peripheral pulmonary lesions were successfully detected and resected by using CBCT with no marking-related complication. Sandwich marking technique was demonstrated to provide safe, reliable, and simple localization procedure for small peripheral pulmonary lesions.
术中识别小的肺结节一直是一个重要的技术问题。我们旨在开发一种新的定位方法，与传统方法相比，该方法更安全且操作简单。
这是一项回顾性研究，纳入了2017年11月至2021年4月在帝京大学医学院和埼玉心血管和呼吸中心接受外周肺结节切除术的患者。所有手术均为楔形切除术，肿瘤大小等于或小于20毫米，这些肿瘤由锥形束计算机断层扫描（CBCT；飞利浦Allura Xper FD 20，飞利浦）检测到。在脏层胸膜的几个位置放置一些金属夹，目标病变被标记夹夹在中间（三明治标记技术）。CBCT同时检测到目标病变和金属夹，并进行了电视辅助胸腔镜手术（VATS）。分析了影像学和病理学结果，并检查了术前、术中和术后肿瘤大小之间的肿瘤大小相关系数。
90例患者的平均年龄为65.2岁，男性47例（52.2%）。所有手术均为楔形切除术，包括12例双楔形切除术，通过三明治标记技术获得了109个外周肺病变。检测率为100%，且无标记相关并发症。
使用CBCT成功检测并切除了所有小的外周肺病变，且无标记相关并发症。三明治标记技术被证明为小的外周肺病变提供了安全、可靠且简单的定位方法。
