Lempel Jason K, Mercado Amiel, Murthy Sudish, Raymond Daniel P, Ahmad Usman, Bullen Jennifer, Bolen Michael A
Department of Radiology, Cleveland Clinic, Cleveland, Ohio.
Department of Thoracic Surgery, Cleveland Clinic, Cleveland, Ohio.
Ann Thorac Surg Short Rep. 2023 Jun 7;1(3):469-473. doi: 10.1016/j.atssr.2023.05.011. eCollection 2023 Sep.
Small nodules and ground-glass opacities can present a challenge when surgeons rely on direct visualization or digital palpation. Preoperative localization improves nodule detection. We aimed to determine the efficacy and safety of video-assisted thoracoscopic surgery (VATS) nodulectomy without intraoperative fluoroscopy after computed tomography (CT)-guided microcoil localization of peripheral pulmonary nodules.
The cases of 147 consecutive patients (152 nodules) who underwent CT-guided microcoil localization (157 coils) followed by same-day VATS resection between 2016 and 2021 were retrospectively reviewed, and descriptive statistics were reported.
All 152 nodules (mean size, 13.5 ± 6.1 mm; mean distance to pleura, 4.2 ± 5.5 mm; 82 [54%] ground-glass nodules, 34 [22%] part-solid nodules) in study patients (mean age, 64.6 ± 11.8 years) were successfully resected. The technical success rate of percutaneous nodule localization with pleural tagging was 96% (150/157); the surgical efficacy of VATS nodulectomy without intraoperative fluoroscopy was 98% (149/152). Twelve patients (8%) required chest tubes after localization. Pathologic examination identified 24 benign and 123 malignant nodules, including 85 primary lung cancers.
CT-guided microcoil localization with pleural tagging is safe and effective and obviates the need for intraoperative fluoroscopy.
当外科医生依靠直接可视化或数字触诊时，小结节和磨玻璃影可能带来挑战。术前定位可提高结节的检出率。我们旨在确定在计算机断层扫描（CT）引导下对周围型肺结节进行微线圈定位后，在无术中透视的情况下进行电视辅助胸腔镜手术（VATS）肺结节切除术的有效性和安全性。
回顾性分析2016年至2021年间147例连续患者（152个结节）的病例，这些患者先接受CT引导下微线圈定位（157个线圈），随后当日行VATS切除术，并报告描述性统计数据。
研究患者（平均年龄64.6±11.8岁）的所有152个结节（平均大小13.5±6.1mm；平均距胸膜距离4.2±5.5mm；82个[54%]磨玻璃结节，34个[22%]部分实性结节）均成功切除。经皮结节定位并胸膜标记的技术成功率为96%（150/157）；无术中透视的VATS肺结节切除术的手术成功率为98%（149/152）。12例（8%）患者在定位后需要放置胸管。病理检查发现24个良性结节和123个恶性结节，其中包括85例原发性肺癌。
CT引导下微线圈定位并胸膜标记安全有效，无需术中透视。
