Hong Jiandong, Luo Taobo, Zhang Yan, Chen Ying, Pan Yang, Xu Haoting, Zeng Jian
School of Medicine, Shaoxing University, Shaoxing, Zhejiang, China.
Department of Pulmonary Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China.
Ann Thorac Cardiovasc Surg. 2025;31(1). doi: 10.5761/atcs.oa.24-00148.
The application of wedge resection in thoracoscopic surgery is becoming more and more widely prevalent. However, achieving precise intraoperative positioning of the pulmonary nodules still poses challenges. This study proposed a method for surface positioning using a computed tomography (CT) simulation positioning system in the radiation physics room.
After screening patients, the level of nodules was located under the CT simulation positioning system, and the pleural projection point of the nodule and the closest surface puncture point from this point to the body surface were determined by the laser positioning system. During the operation, a needle was inserted at a predetermined angle at the puncture point, leaving a pinhole in the visceral pleura. Finally, the distance between the true pleural projection point of the nodule and the pinhole was measured on the specimen.
The success rate of our positioning method was 97.2%. The average distance between the puncture pinhole location and the actual pleural projection point of the nodule was 8.1 mm. No related complications occurred during the perioperative period.
The new method of preoperative surface positioning and intraoperative lung positioning through puncture has a high success rate, good positioning accuracy, and good safety, which is worthy of clinical application.
楔形切除术在胸腔镜手术中的应用越来越广泛。然而，实现肺结节的精确术中定位仍具有挑战性。本研究提出了一种在放射物理室使用计算机断层扫描（CT）模拟定位系统进行体表定位的方法。
筛选患者后，在CT模拟定位系统下确定结节水平，通过激光定位系统确定结节的胸膜投影点以及从该点到体表最近的表面穿刺点。手术过程中，在穿刺点以预定角度插入一根针，在内脏胸膜上留下一个针孔。最后，在标本上测量结节的真实胸膜投影点与针孔之间的距离。
我们的定位方法成功率为97.2%。穿刺针孔位置与结节实际胸膜投影点之间的平均距离为8.1毫米。围手术期未发生相关并发症。
术前体表定位和术中经穿刺进行肺定位的新方法成功率高、定位精度好、安全性好，值得临床应用。
