CT引导下微弹簧圈定位在肺小结节楔形切除术中的应用
|
摘要
目的探讨CT引导下定位置入微弹簧圈在肺小结节楔形切除术中的临床应用。方法对12例肺小结节患者在CT引导下细针穿刺,采用"两步释放法":将一小部分微弹簧圈释放在病变附近5mm范围内,一部分弹簧圈留在脏层胸膜表面,根据肺小结节及弹簧圈位置来确定切除结节周围肺组织范围,在胸腔镜下行肺局部楔形切除,将离体组织进行快速冰冻、组织学观察,根据病变的良恶性指导临床继续扩大手术或结束治疗。结果 12例肺小结节行CT扫描均能清晰显示病灶,置入弹簧圈,成功术前定位,并行胸腔镜下肺楔形切除术,全组患者手术顺利,无严重手术并发症和围手术期死亡,术后病理诊断:原发性肺癌4例(33.3%),不典型腺瘤样增生2例(16.7%),错构瘤1例(8.3%),炎性病变5例(41.7%)。结论 CT引导下定位置入微弹簧圈在肺内小结节楔形切除术中的应用是安全、有效的,可以帮助胸外科医师与病理医师快速、准确找到病灶,指导临床治疗。
Objective To investigate the clinical application of CT guided localization by implanting microcoils before small pulmonary nodules wedge resection. Methods 12 cases of patients with small pulmonary nodules was conducted fine needle aspiration with CT scanning,adopted "two steps to release",to release the little part of microcoil around the lesions within 5 mm,to retain the part of the microcoil in surface of visceral pleura,to determine the scope of the resected lung tissue surrounding nodules according to the position of small pulmonary nodules and microcoils. And in vitro tissue is rapidly frozen for histological observation behind thoracoscopic pulmonary wedge resection. To continue expanding the operation or end clinical treatment according to malignant or benign lesions. Results CT scanning of 12 cases with small pulmonary nodules can clearly show lesions. Preoperative localization is successful by implanting microcoils. And the patients received thoracoscopic wedge resection,All of them underwent the operation successfully without severe complications and perioperative death,The postoperative pathological diagnosis included primary pulmonary carcinoma( n = 4,33. 3%),atypical adenomatous hyperplasia( n = 2,16. 7%),hamartoma( n =1,8. 3%),inflammatory lesions( n = 5,41. 7%). Conclusion CT guided localization by using microcoils before small pulmonary nodules wedge resection is safe and effective. It can help thoracic surgeons and pathologists find lesions quickly and accurately to guide clinical treatment.
Objective To investigate the clinical application of CT guided localization by implanting microcoils before small pulmonary nodules wedge resection. Methods 12 cases of patients with small pulmonary nodules was conducted fine needle aspiration with CT scanning,adopted "two steps to release",to release the little part of microcoil around the lesions within 5 mm,to retain the part of the microcoil in surface of visceral pleura,to determine the scope of the resected lung tissue surrounding nodules according to the position of small pulmonary nodules and microcoils. And in vitro tissue is rapidly frozen for histological observation behind thoracoscopic pulmonary wedge resection. To continue expanding the operation or end clinical treatment according to malignant or benign lesions. Results CT scanning of 12 cases with small pulmonary nodules can clearly show lesions. Preoperative localization is successful by implanting microcoils. And the patients received thoracoscopic wedge resection,All of them underwent the operation successfully without severe complications and perioperative death,The postoperative pathological diagnosis included primary pulmonary carcinoma( n = 4,33. 3%),atypical adenomatous hyperplasia( n = 2,16. 7%),hamartoma( n =1,8. 3%),inflammatory lesions( n = 5,41. 7%). Conclusion CT guided localization by using microcoils before small pulmonary nodules wedge resection is safe and effective. It can help thoracic surgeons and pathologists find lesions quickly and accurately to guide clinical treatment.
引文
[1]宋勇,姚艳雯.肺部小结节的诊断和治疗近况[J].中华肺部疾病杂志(电子版),2012,5:1-4.
[2]王俊,刘彦国.肺内小结节的诊治现状,问题和方向[J].中华胸心血管外科杂志,2012,28(2):385-386.
[3]Henschke CI,Yankelevitz DF,Miacheva R,et al.CT screening for lung cancer:frequency and significance of part-solid and nonsolid nodules[J].AJR,2002,178(4):1053-1057.
[4]Detterbeck FC,Homer RJ.Approach to the ground-glass nodule[J].Clin Chest Med,2011,32(4):799-810.
[5]Kim TJ,Goo JM,Lee KW,et al.Clinical,pathological and thin-section CT features of persistent multiple ground-glass opacity nodules:comparison with solitary ground-glass opacity nodule[J].Lung Cancer,2009,64(1):171-178.
[6]Takashima S,Maruyama Y,Hasegawa M,et al.CT findings and progression of small peripheral lung neoplasms having a replacement growth pattern[J].AJR,2003,180(4):817-826.
[7]Travis WD,Brambilla E,Noguchi M,et al.International association for the study of lung cancer:Americanthoracic society and European respiratory society international multidis ciplinary classification of lung adenocarcinoma[J].J Thorac Oncol,2011,6(2):244-285.
[8]王升平,李文涛,彭卫军,等.胸腔镜术前CT引导下Hook-wire定位肺内结节性病灶[J].中华放射学杂志,2010,44(5):518-522.
[9]许彪,陈刚,韦璐,等.多层螺旋CT导向经皮肺穿刺活检的临床应用[J].医学影像学杂志,2008,18(11):1336-1338.
[10]Powell TI,Jangra D,Clifton JC,et al.Peripheral lung nodules:fluoroscopically guided video-assisted thoracoscopic resection after computed tomography guided localization using platinum microcoils[J].Annsurg,2004,240:481-488.
[2]王俊,刘彦国.肺内小结节的诊治现状,问题和方向[J].中华胸心血管外科杂志,2012,28(2):385-386.
[3]Henschke CI,Yankelevitz DF,Miacheva R,et al.CT screening for lung cancer:frequency and significance of part-solid and nonsolid nodules[J].AJR,2002,178(4):1053-1057.
[4]Detterbeck FC,Homer RJ.Approach to the ground-glass nodule[J].Clin Chest Med,2011,32(4):799-810.
[5]Kim TJ,Goo JM,Lee KW,et al.Clinical,pathological and thin-section CT features of persistent multiple ground-glass opacity nodules:comparison with solitary ground-glass opacity nodule[J].Lung Cancer,2009,64(1):171-178.
[6]Takashima S,Maruyama Y,Hasegawa M,et al.CT findings and progression of small peripheral lung neoplasms having a replacement growth pattern[J].AJR,2003,180(4):817-826.
[7]Travis WD,Brambilla E,Noguchi M,et al.International association for the study of lung cancer:Americanthoracic society and European respiratory society international multidis ciplinary classification of lung adenocarcinoma[J].J Thorac Oncol,2011,6(2):244-285.
[8]王升平,李文涛,彭卫军,等.胸腔镜术前CT引导下Hook-wire定位肺内结节性病灶[J].中华放射学杂志,2010,44(5):518-522.
[9]许彪,陈刚,韦璐,等.多层螺旋CT导向经皮肺穿刺活检的临床应用[J].医学影像学杂志,2008,18(11):1336-1338.
[10]Powell TI,Jangra D,Clifton JC,et al.Peripheral lung nodules:fluoroscopically guided video-assisted thoracoscopic resection after computed tomography guided localization using platinum microcoils[J].Annsurg,2004,240:481-488.