【摘要】：目的肺部結(jié)節(jié)在手術(shù)中的定位一直是臨床中的難題。文中討論CT引導(dǎo)下彈簧圈定位結(jié)合數(shù)字減影血管造影術(shù)(digital subtraction angiography,DSA)實(shí)時(shí)導(dǎo)向電視胸腔鏡手術(shù)(video-assisted thoracoscopic surgery,VATS)精準(zhǔn)切除孤立性肺結(jié)節(jié)(solitary pulmonary nodule,SPN)的診療價(jià)值。方法收集2011年9月至2014年5月間南京軍區(qū)南京總醫(yī)院心胸外科收治的SPN患者82例�；颊呔谑中g(shù)當(dāng)天在CT引導(dǎo)下經(jīng)皮穿刺,緊貼病灶放置金屬彈簧圈定位,隨后送入雜交手術(shù)室。術(shù)中結(jié)合DSA實(shí)時(shí)導(dǎo)向行VATS楔形切除SPN,再根據(jù)術(shù)中快速病理結(jié)果行下一步處理。結(jié)果金屬彈簧圈定位成功率100%,平均定位時(shí)間(15.3±3.2)min,VATS楔形平均切除手術(shù)時(shí)間(24.2±12.1)min,術(shù)后病理結(jié)果顯示惡性病變45例、良性病變37例,無嚴(yán)重并發(fā)癥。結(jié)論 SPN在術(shù)前CT引導(dǎo)下置入彈簧圈標(biāo)記定位準(zhǔn)確率高。結(jié)合DSA實(shí)時(shí)導(dǎo)向行VATS切除可精準(zhǔn)切除病灶,并確保切緣距離病灶2 cm以上,達(dá)到SPN診治一體化的目的。
[Abstract]:Objective the localization of pulmonary nodules in surgery is always a difficult problem. This paper discusses the diagnostic and therapeutic value of CT guided coils localization combined with digital subtraction angiography (digital subtraction angiography,DSA) real-time guided video-assisted thoracoscopic surgery (video-assisted thoracoscopic surgery,VATS) for the accurate removal of solitary pulmonary nodules (solitary pulmonary nodule,SPN). Methods from September 2011 to May 2014, 82 patients with SPN were treated in Department of Cardiothoracic surgery, Nanjing General Hospital of Nanjing military region. All the patients underwent percutaneous puncture guided by CT on the day of operation and placed metal coils close to the focus, which were then sent to hybrid operating room. VATS wedge resection combined with DSA real-time VATS wedge resection was performed during the operation and the next step was performed according to the rapid pathological results of the operation. Results the success rate of metal coil localization was 100%. The mean localization time was (15.3 鹵3.2) min,VATS wedge-shaped resection time (24.2 鹵12.1) min,. The pathological results showed malignant lesions in 45 cases and benign lesions in 37 cases. There were no serious complications. Conclusion SPN has a high accuracy in locating the coils under the guidance of CT before operation. VATS resection combined with DSA real-time guidance can accurately remove the lesions and ensure that the margin is more than 2 cm away from the focus, thus achieving the goal of integrating the diagnosis and treatment of SPN.
【作者單位】： 南京軍區(qū)南京總醫(yī)院心胸外科;南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科;
【基金】：國家自然科學(xué)基金(81172032)
【分類號】：R816.4;R563

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本文編號：2237216