南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (05): 718-722.doi: 10.12122/j.issn.1673-4254.2020.05.17

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单孔胸腔镜手术术前定位技术的应用价值：基于54例孤立性肺结节的临床观察

廖 明，何 哲，徐恩五，吴德华   

  • 出版日期:2020-05-20 发布日期:2020-05-20
  • 基金资助:

Value of preoperative localization techniques for solitary pulmonary nodules in singleport thoracoscopic surgery

  

  • Online:2020-05-20 Published:2020-05-20

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摘要： 目的 探讨不同结节定位技术在孤立性肺结节（SPN）单孔胸腔镜手术术前定位中的应用价值及临床效果。方法 选取中国人民解放军南部战区总医院胸外科自2018年1月~2019年6月间收治的54例诊断为SPN并采取单孔胸腔镜手术进行治疗的 患者为研究对象进行回顾性分析，其中男30例，女24例；年龄17~78岁，平均年龄41岁。依据结节定位方法将上述患者分为2组：A组34例，采取术前CT导下Hook-wire定位（Hook-wire采用乳腺常用定位针）；B组20例，采取术前CT引导下亚甲蓝定位（以心内注射针穿刺至结节表面肺组织注射少量亚甲蓝染色）。结果 A组定位成功率为94.18％（32/34），B组定位成功率为85%（17/20，其余3例于术中通过手指触摸定位后切除），两组差异有统计学意义（P<0.05）；A组患者术中未出现中转开胸，B组中转开胸率为10%（2/20），两组差异有统计学意义（P<0.05）；A组定位费用为1715±109元，B组定位费用为1021±86元，两组差异有统计学意义（P<0.05）；A组住院总费用为50114±3788元，B组住院总费用为47871±5902元，两组差异无统计学意义（P>0.05）；A组住院天数为6.71±1.23 d，B组住院天数为8.19±2.61 d，两组差异有统计学意义（P<0.05）。结论 采用单孔胸腔镜手术进行SPN的切除有助于将患者的创伤降至最低，合理选择术前定位技术可提高肺结节切除的精确率，对于SPNs的鉴别诊断及治疗具有很好的临床应用价值。Hook-wire定位法相比较于传统亚甲蓝定位法可显著增加定位成功率，可作为单孔胸腔镜肺结节切除手术，特别是结节位置距脏层胸膜较深的患者术前的标准定位方法。

Abstract: Objective To evaluate the value and clinical effect of different preoperative localization techniques for solitary pulmonary nodules (SPN) before single-port thoracoscopic surgery. Method From January 2018 to June 2019, 54 patients diagnosed with solitary pulmonary nodules received single-port thoracoscopic surgery in Thoracic Department of General Hospital of Southern Theater Command of PLA. Based on the location methods of the nodules, the patients were divided into group A (34 cases) with preoperative CT-guided Hook-wire (a common positioning needle usually using in mammary gland) positioning and group B (20 cases) with preoperative CT-guided methylene blue location. Results The success rate of localization in group A was 94.18% (32/34), significantly higher than that in group B [85% (17/20), P<0.05). No intraoperative conversion to thoracotomy occurred in group A, while the conversion rate was 10% (2/20) in group B (P<0.05). The average positioning cost was significantly higher in group A than in group B (1715±109 vs 1021±86 RMB yuan, P<0.05), but the total hospitalization cost was similar between the two groups (50 114±3788 vs 47871±5902 RMB yuan, P>0.05). The length of hospital stay was significantly shorter in group A than in group B (6.71±1.23 vs 8.19±2.61 days, P<0.05). Conclusion Compared with the traditional methylene blue localization method, Hook-wire localization positioning can significantly increase the success rate of localization, and can be used as the standard preoperative localization method in patients undergoing single-port thoracoscopic pulmonary nodule resection, especially in those with deep nodule location from the visceral pleura.