氩气刀定位法在胸腔镜肺楔形切除手术中的应用
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摘要
目的探讨氩气刀定位法在胸腔镜肺楔形切除手术中的应用价值。方法 2015年1月～2018年1月,对63例肺部小结节(直径≤2 cm)采用氩气刀定位法实施单操作孔胸腔镜肺楔形切除术。病灶均为单发,最大径0. 8～2 cm,(1. 22±0. 34) cm,均位于肺边缘,CT上测量病灶距离脏层胸膜0. 5～3 cm,(1. 67±0. 54) cm。在CT上确定病灶的肋间层面及钟位方向,在胸腔镜下将病灶虚拟投影在壁层胸膜表面。氩气刀标记投影点,膨肺后再次喷射氩气,标记病灶在肺脏层胸膜表面的投影点,楔形切除病灶,根据冰冻病理结果决定下一步手术方案。结果 61例(96. 8%)在楔形切除标本中找到病灶,2例定位失败。行肺楔形切除53例,解剖性肺段切除2例,肺叶切除8例。术后病理证实肺癌58例,良性病变5例。结论氩气刀定位法对胸腔镜术中肺内小结节的定位实用、可靠,值得临床推广。
Objective To investigate the value of argon knife localization in the operation of thoracoscopic wedge resection.Methods From January 2015 to January 2018,63 cases of small pulmonary nodules( diameter ≤ 2 cm) were treated with argon knife localization for single utility port thoracoscopic wedge resection. The lesions were all solitary nodule located at the edge of the lung parenchyma,with a maximum diameter of 0. 8-2 cm( mean,1. 22 ± 0. 34 cm). The distance from lesion site to the visceral pleura was measured with CT films,which ranged 0. 5-3 cm( mean,1. 67 ± 0. 54 cm). The intercostal layer and the clock localization of the lesion were first determined on the CT,and then the lesion was virtually projected on the parietal pleural surface under thoracoscopy. The argon knife was used to mark the projection point. The argon gas was sprayed again after the lung re-expansion,and the projection point of the lesion on the surface of the pleural was marked. The lesions were then given a wedge resection. Following surgical plan was decided according to the frozen pathological results of the lesions. Results The lesions were located and found in wedge resection specimens in 61 cases( 96. 8%),while we failed to locate the lesions in 2 cases. A total of 53 patients underwent wedge resection,2 underwent anatomical segmentectomy,and 8 underwent lobectomy. Postoperative pathology confirmed 58 cases of lung cancer and 5 cases of benign lesions. Conclusion Argon knife localization for small pulmonary nodules in the operation of thoracoscopic surgery is practical and reliable,and it is worthy of clinical promotion.
Objective To investigate the value of argon knife localization in the operation of thoracoscopic wedge resection.Methods From January 2015 to January 2018,63 cases of small pulmonary nodules( diameter ≤ 2 cm) were treated with argon knife localization for single utility port thoracoscopic wedge resection. The lesions were all solitary nodule located at the edge of the lung parenchyma,with a maximum diameter of 0. 8-2 cm( mean,1. 22 ± 0. 34 cm). The distance from lesion site to the visceral pleura was measured with CT films,which ranged 0. 5-3 cm( mean,1. 67 ± 0. 54 cm). The intercostal layer and the clock localization of the lesion were first determined on the CT,and then the lesion was virtually projected on the parietal pleural surface under thoracoscopy. The argon knife was used to mark the projection point. The argon gas was sprayed again after the lung re-expansion,and the projection point of the lesion on the surface of the pleural was marked. The lesions were then given a wedge resection. Following surgical plan was decided according to the frozen pathological results of the lesions. Results The lesions were located and found in wedge resection specimens in 61 cases( 96. 8%),while we failed to locate the lesions in 2 cases. A total of 53 patients underwent wedge resection,2 underwent anatomical segmentectomy,and 8 underwent lobectomy. Postoperative pathology confirmed 58 cases of lung cancer and 5 cases of benign lesions. Conclusion Argon knife localization for small pulmonary nodules in the operation of thoracoscopic surgery is practical and reliable,and it is worthy of clinical promotion.
引文
1李文涛,瞿冀琛,徐志飞.钟表盘综合定位法在胸腔镜手术治疗肺内结节的应用.中国胸心血管外科杂志,2015,31(4):209-212.
2 钱俊,周超,沈宇舟,等.钟表盘综合定位法单操作孔胸腔镜在高龄(≥70岁)肺肿瘤患者中的应用.中国微创外科杂志,2018,18(5):397-400.
3 陈东红,支修益.亚肺叶切除治疗早期非小细胞肺癌.首都医科大学学报,2014,35(6):689-693.
4 王俊,赵辉.肺叶切除治疗早期肺癌需要考虑的几个问题.中国肺癌杂志,2016,19(6):351-354.
5 支修益,石远凯,于金明.中国原发性肺癌诊疗规范(2015年版).中华肿瘤杂志,2015,37(1):67-78.
6 许志扬,许建新,关军,等.微弹簧圈定位在胸腔镜肺小结节切除术中的应用.中国微创外科杂志,2017,17(3):228-230.
7 付小伟,王军岐,贾永,等.医用胶标记在肺部小结节胸腔镜手术前定位的应用.中国微创外科杂志,2017,17(12):1071-1073.
8 贾春祎,陈海泉,王启文,等. CT引导Hookwire定位下电视胸腔镜手术对孤立性肺小结节的诊疗价值.中国癌症杂志,2013,23(11):917-920.
9 Yoshida Y,Inoh S,Murakawa T,et al. Preoperative localization of small peripheral pulmonary nodules by percutaneous marking under computed tomography guidance. Interact Cardiovasc Thorac Surg,2011,13(1):25-28.
10 Eichfeld U,Dietrich A,Ott R,et al. Video-assisted thoracoscopic surgery for pulmonary nodules after computed tomography-guided marking with a spiral wire. Ann Thorac Surg,2005,79(1):313-316.
11 马千里,刘德若,孙宏亮,等. CT三维重建精确定位肺小结节和磨玻璃影在胸腔镜亚肺叶切除中的应用.中华胸心血管外科杂志,2016,32(3):175-177.
12 隋锡朝,赵辉,王俊.肺微小结节和肺内磨玻璃影的定位方法.中华胸心血管外科杂志,2013,29(9):555-557.
2 钱俊,周超,沈宇舟,等.钟表盘综合定位法单操作孔胸腔镜在高龄(≥70岁)肺肿瘤患者中的应用.中国微创外科杂志,2018,18(5):397-400.
3 陈东红,支修益.亚肺叶切除治疗早期非小细胞肺癌.首都医科大学学报,2014,35(6):689-693.
4 王俊,赵辉.肺叶切除治疗早期肺癌需要考虑的几个问题.中国肺癌杂志,2016,19(6):351-354.
5 支修益,石远凯,于金明.中国原发性肺癌诊疗规范(2015年版).中华肿瘤杂志,2015,37(1):67-78.
6 许志扬,许建新,关军,等.微弹簧圈定位在胸腔镜肺小结节切除术中的应用.中国微创外科杂志,2017,17(3):228-230.
7 付小伟,王军岐,贾永,等.医用胶标记在肺部小结节胸腔镜手术前定位的应用.中国微创外科杂志,2017,17(12):1071-1073.
8 贾春祎,陈海泉,王启文,等. CT引导Hookwire定位下电视胸腔镜手术对孤立性肺小结节的诊疗价值.中国癌症杂志,2013,23(11):917-920.
9 Yoshida Y,Inoh S,Murakawa T,et al. Preoperative localization of small peripheral pulmonary nodules by percutaneous marking under computed tomography guidance. Interact Cardiovasc Thorac Surg,2011,13(1):25-28.
10 Eichfeld U,Dietrich A,Ott R,et al. Video-assisted thoracoscopic surgery for pulmonary nodules after computed tomography-guided marking with a spiral wire. Ann Thorac Surg,2005,79(1):313-316.
11 马千里,刘德若,孙宏亮,等. CT三维重建精确定位肺小结节和磨玻璃影在胸腔镜亚肺叶切除中的应用.中华胸心血管外科杂志,2016,32(3):175-177.
12 隋锡朝,赵辉,王俊.肺微小结节和肺内磨玻璃影的定位方法.中华胸心血管外科杂志,2013,29(9):555-557.