Hu Libao, Gao Jian, Hong Nan, Liu Huixin, Zhi Xin, Zhou Jian
Department of Radiology, Peking University People's Hospital, No. 11 Xizhimen South Avenue, Beijing, China.
Department of Clinical Epidemiology, Peking University People's Hospital, No. 11 Xizhimen South Avenue, Beijing, China.
Eur Radiol. 2024 Mar;34(3):1587-1596. doi: 10.1007/s00330-023-10152-x. Epub 2023 Sep 1.
To retrospectively evaluate the efficacy and safety of CT-guided microcoil localization of pulmonary nodules before video-assisted thoracoscopic surgery (VATS).
A total of 1059 consecutive patients with 1331 pulmonary nodules treated between July 2018 and April 2021 were included in this study. Of the 1331 nodules, 1318 were localized using the tailed method and 13 were localized using the non-tailed method. The localization technical success rate and complications of the microcoil localization procedure were assessed. Univariate and multivariate logistic regression analyses were used to determine potential risk factors for technical failure, pneumothorax, and pulmonary hemorrhage.
The technical success rate of the localization procedure was 98.4% (1310/1331 nodules). Nodule location in the lower lobes (p = 0.015) and need for a longer needle path (p < 0.001) were independent predictors of technical failure. All localization procedure-related complications were minor (grade 1 or 2) adverse events, with the exception of one grade 3 complication. The most common complications were pneumothorax (302/1331 nodules [22.7%]) and pulmonary hemorrhage (328/1331 nodules [24.6%]). Male sex (p = 0.001), nodule location in the middle (p = 0.003) and lower lobes (p = 0.025), need for a longer needle path (p < 0.001), use of transfissural puncture (p = 0.042), and simultaneous multiple localizations (p < 0.001) were independent risk factors for pneumothorax. Female sex (p = 0.015), younger age (p = 0.023), nodules location in the upper lobes (p = 0.011), and longer needle path (p < 0.001) were independent risk factors for pulmonary hemorrhage.
CT-guided microcoil localization of pulmonary nodules before VATS using either the tailed or non-tailed method is effective and safe.
CT-guided microcoil localization of pulmonary nodules before VATS resection is effective and safe when using either the tailed or non-tailed method. Nodules requiring transfissural puncture and multiple nodules requiring simultaneous localizations can also be successfully localized with this method.
• Pre-VATS CT-guided microcoil localization of pulmonary nodules by tailed or non-tailed method was effective and safe. • When the feasible puncture path was beyond the scope of wedge resection, localization could be performed using the non-tailed method. • Although transfissural puncture and simultaneous multiple localization were independent risk factors for pneumothorax, they remained clinically feasible.
回顾性评估在电视辅助胸腔镜手术（VATS）前CT引导下微线圈定位肺结节的有效性和安全性。
本研究纳入了2018年7月至2021年4月期间连续治疗的1059例患者的1331个肺结节。在这1331个结节中，1318个采用带尾法定位，13个采用无尾法定位。评估微线圈定位操作的技术成功率和并发症。采用单因素和多因素逻辑回归分析确定技术失败、气胸和肺出血的潜在危险因素。
定位操作的技术成功率为98.4%（1310/1331个结节）。下叶结节位置（p = 0.015）和需要更长的针道（p < 0.001）是技术失败的独立预测因素。除1例3级并发症外，所有与定位操作相关的并发症均为轻微（1级或2级）不良事件。最常见的并发症是气胸（302/1331个结节[22.7%]）和肺出血（328/1331个结节[24.6%]）。男性（p = 0.001）、中叶（p = 0.003）和下叶结节位置（p = 0.025）、需要更长的针道（p < 0.001）、使用经裂面穿刺（p = 0.042）和同时进行多个定位（p < 0.001）是气胸的独立危险因素。女性（p = 0.015）、年龄较小（p = 0.023）、上叶结节位置（p = 0.011）和更长的针道（p < 0.001）是肺出血的独立危险因素。
在VATS前使用带尾或无尾法进行CT引导下肺结节微线圈定位是有效且安全的。
在VATS切除术前，使用带尾或无尾法进行CT引导下肺结节微线圈定位是有效且安全的。需要经裂面穿刺的结节和需要同时定位的多个结节也可以用这种方法成功定位。
• VATS前通过带尾或无尾法进行CT引导下肺结节微线圈定位是有效且安全 的。 • 当可行的穿刺路径超出楔形切除范围时，可采用无尾法进行定位。 • 虽然经裂面穿刺和同时进行多个定位是气胸的独立危险因素，但在临床上仍然可行。
