术前CT引导Hook-wire定位同时性多原发性肺癌的诊疗价值

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摘要目的评估电视胸腔镜手术（VATS）术前行CT引导下Hook-wire定位对治疗同时性多原发性肺癌（SMPLC）的有效性及安全性。方法回顾性分析自2011年2月~2016年12月，东南大学附属江阴市人民医院胸外科收治的SMPLC患者47例，所有患者均在CT引导下留置Hook-wire定位针，并行VATS切除病灶，根据术中冰冻病理结果决定进一步手术方式。统计定位准确率、VATS切除成功率、并发症发生率等。结果 47例SMPLC患者中，单侧SMPLC患者19例，双侧SMPLC患者28例。CT引导下带钩钢丝定位成功率为100%，定位时间为（34.98±5.95）min。患者定位后发生少量气胸（肺压缩<20%）7例（14.9%），无需处理。定位过程中发生中等量气胸（肺压缩≥20%）4例（8.6%），在手术过程中发生对侧气胸2例（4.3%），VATS探查过程中出现少量出血（≤50 mL）2例（4.3%），均未出现进行性血胸，未找到病理标本1例（2.1%），中转开胸手术2例（4.3%）。所有患者均为未发现定位针移位和脱落。结论术前CT引导下Hook-wire定位准确、安全、并发症少，对SMPLC的VATS诊治具有良好的临床价值。

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	虞桂平1 单一波1 黄斌1 姜格宁2

关键词 ：同时性多原发性肺癌, Hook-wire, 电视胸腔镜手术, CT扫描

Abstract：Objective To evaluate the efficacy and safety of CT-guided Hook-wire localization in the treatment of synchronous multiple primary lung cancer (SMPLC) before video-assisted thoracoscopic surgery (VATS). Methods From February 2011 to December 2016, 47 patients with SMPLC admitted to the thoracic surgery department of Jiangyin People′s Hospital Affiliated to Southeast University were retrospectively analyzed. All patients were treated with Hook-wire localization needle under CT guidance, and VATS was performed to remove the lesions. Further surgical methods were determined according to the frozen pathological results during the operation. Positioning accuracy, the success rate of VATS lung lesion resection surgery, postoperative complications and other indicators were calculated. Results Among 47 patients, there were 19 patients with unilateral SMPLC and 28 with bilateral SMPLC. All resections of lesions which guided by the inserted Hook-wire were successfully performed by VATS (success rate was 100%). The mean procedure time for the CT-guided Hook-wire localization was (34.98±5.95) min. The major complication of CT-guided Hook-wire localization was slight pneumothorax (lung compression<20%) in 7 patients(14.9%), no one needed chest tube drainage. Moderate pneumothora (lung compression ≥20%) were observed in 4 patients(8.6%). Contralateral pneumothorax occurred during operation in 2 patients (4.3%). Two patients (4.3%) had minimal hemothorax (≤50 mL) during VATS. One patient (2.1%) underwent additional wedge resection by VATS during the same procedure because no lesion was identified in the surgical specimen. Conversion thoracotomy were required in 2 patients (4.3%) for pleural adhesions. None of Hook-wires dislodged or displaced during the transport to the surgical suite. Conclusion Preoperative CT-guided Hook-wire localization is accurate, safe and has less complications. It is of great clinical value in the diagnosis and treatment of SMPLC for VATS.

Key words： Synchrony multiple primary lung cancer Hook-wire Video-assisted thoracoscopic surgery CT scan

基金资助:江苏省卫生计生委医学科研课题（H201657）；
江苏省无锡市卫生计生科研项目（MS201625）；
吴阶平医学基金会临床科研专项资助基金课题（320.6750.1 8139）。

引用本文:

虞桂平1 单一波1 黄斌1 姜格宁2. 术前CT引导Hook-wire定位同时性多原发性肺癌的诊疗价值[J]. 中国医药导报, 2019, 16(11): 81-84.
YU Guiping1 SHAN Yibo1 HUANG Bin1 JIANG Gening2. Diagnostic and therapeutic value of preoperative CT-guided Hook-wire localization for synchronous multiple primary lung cancer. 中国医药导报, 2019, 16(11): 81-84.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2019/V16/I11/81

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