Peterson M S, Cohen C S, Landreneau R J
Department of Radiology, University of Pittsburgh Medical Center, PA 15213.
AJR Am J Roentgenol. 1993 May;160(5):987-93. doi: 10.2214/ajr.160.5.8470614.
Laser-assisted thoracic surgery (performed through a thoracotomy or as an endoscopic procedure with thoracoscopy [pleural endoscopy]) is being used increasingly for lung-sparing resections of neoplasms, biopsies, and ablation of bullae. The technique is useful in treating patients who have limited pulmonary reserve and may avoid the problem of distortion of surrounding pulmonary tissue. Because laser energy causes injury to lung tissue, postoperative radiographs may show findings unique to the laser-assisted technique. The objective of this study was to determine postoperative radiographic findings common to laser-assisted surgery.
Pre- and postoperative and all follow-up chest radiographs were reviewed for 52 consecutive patients who had 60 laser-assisted thoracic surgical procedures (35 with an open thoracotomy, 25 with thoracoscopy) for resection of peripheral nodules (40), biopsy of focal (five) or diffuse (four) lung disease, or ablation of bullae (three). Postoperative chest CT studies available for 20 patients also were reviewed. All postoperative radiographic studies were evaluated for the presence and duration of pneumothoraces, pleural effusions, areas of parenchymal opacification or cavitation, and complications requiring surgical or radiologic intervention.
Pneumothoraces and pleural effusions were seen in 88% and 83% of cases, respectively, and were typically small, uncomplicated, and of limited duration. Nonspecific parenchymal opacification of various degrees was observed at the operative site in all cases and usually regressed within days or weeks to areas of parenchymal scarring. Parenchymal cavitation at the operative site occurred in 15 patients (29%). Eight patients (15%) had complications that required intervention, primarily prolonged air leaks and pleural space complications.
Radiographic findings after laser-assisted thoracic surgery are often nonspecific and of limited duration. In an asymptomatic patient, cavitation at the operative site is a normal finding related to the surgical technique and should not be misdiagnosed as infection or tumor. Radiographic findings normally resolve to stable cavitary or linear scars.
激光辅助胸外科手术（通过开胸手术进行或作为胸腔镜检查[胸膜内镜检查]的内镜手术）越来越多地用于肺部肿瘤的保留肺叶切除术、活检以及肺大疱消融。该技术对治疗肺储备有限的患者很有用，并且可以避免周围肺组织变形的问题。由于激光能量会对肺组织造成损伤，术后X线片可能会显示出激光辅助技术特有的表现。本研究的目的是确定激光辅助手术常见的术后影像学表现。
对连续52例患者进行了术前、术后及所有随访胸部X线片检查，这些患者共接受了60例激光辅助胸外科手术（35例开胸手术，25例胸腔镜手术），用于切除周围结节（40例）、局灶性（5例）或弥漫性（4例）肺部疾病活检或肺大疱消融（3例）。还对20例患者的术后胸部CT研究进行了回顾。对所有术后影像学研究评估气胸、胸腔积液、实质浑浊或空洞区域的存在及持续时间，以及需要手术或放射学干预的并发症。
分别有88%和83%的病例出现气胸和胸腔积液，通常量小、无并发症且持续时间有限。所有病例在手术部位均观察到不同程度的非特异性实质浑浊，通常在数天或数周内消退为实质瘢痕区域。手术部位实质空洞形成发生在15例患者（29%）中。8例患者（15%）出现需要干预的并发症，主要是持续性漏气和胸腔并发症。
激光辅助胸外科手术后的影像学表现通常是非特异性的，且持续时间有限。在无症状患者中，手术部位的空洞是与手术技术相关的正常表现，不应误诊为感染或肿瘤。影像学表现通常会消退为稳定的空洞或线性瘢痕。
