術前CT引導Hook—wire定位同時性多原發性肺癌的診療價值.doc

術前CT引導Hook—wire定位同時性多原發性肺癌的診療價值
[摘要] 目的 評估電視胸腔鏡手術(VATS)術前行CT引導下Hook-wire定位對治療同時性多原發性肺癌(SMPLC)的有效性及安全性。 方法 回顧性分析自2PLC. 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
多原發性肺癌(multiple primary lung cancer,MPLC)是指在同一患者肺內不同部位同時或先后發生兩個或兩個以上原發病灶的肺癌,根據多個癌灶發生的時間先后順序,多原發性肺癌可分為同時性多原發性肺癌和異時性多原發性肺癌兩類。同時性多原發性肺癌(synchronous multiple primary lung cancer,SMPLC)是指兩個或多個癌腫病灶同時發生[1-2]。近年來,隨著健康體檢意識增強以及影像學技術的不斷提高,尤其是高分辨CT在臨床的廣泛應用,對肺部多發結節的檢出率也明顯提高[3]。其中相當一部分小結節由于直徑較小,位置較深或密度較小,易造成行胸腔鏡手術時的觸診定位困難,進而影響手術方式選擇,延長手術時間,給手術醫生帶來了治療困難,給患者增加了不必要的痛苦。目前,完整切除病灶是SMPLC的首選診療方法[4],而病灶的術中準確定位是手術成功的關鍵。術前胸部CT引導下的Hook-wire定位輔以胸腔鏡手術活檢是一種定位準確且安全有效的方法。本研究中,47例SMPLC患者于行電視胸腔鏡手術(VATS)前行CT引導下Hook-wire帶鉤鋼絲定位,評估其有效性和安全性。
1 資料與方法
1.1 一般資料
選取2011年2月~2016年12月東南大學附屬江陰市人民醫院胸外科收治的47例SMPLC患者,均行VATS并在術前行Hook-wire定位。其中單側SMPLC 19例,男13例,女6例;年齡32~79歲,平均(58.5±10.2)歲;術后病理類型