本文選題：肺內(nèi)磨玻璃密度結(jié)節(jié)　切入點(diǎn)：CT引導(dǎo)下定位　出處：《大連醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：回顧分析肺內(nèi)磨玻璃密度結(jié)節(jié)（ground-glass nodules, GGNs）胸腔鏡術(shù)前CT引導(dǎo)下Hook-wire定位的臨床應(yīng)用并總結(jié)操作經(jīng)驗(yàn)。分析GGNs距離胸膜的深度與定位針偏離誤差的關(guān)系，探討CT引導(dǎo)下Hook-wire定位術(shù)的適應(yīng)癥并規(guī)范操作。 資料與方法：對81名肺部病變患者（81名患者中男性28例，女性53例。年齡24~77歲，平均年齡58歲）的93枚肺內(nèi)GGNs進(jìn)行CT引導(dǎo)下Hook-wire定位，隨后進(jìn)行胸腔鏡微創(chuàng)病灶楔形切除術(shù)。CT掃描機(jī)采用美國GE Lightspeed16螺旋CT，定位針均采用美國Angiotech公司的Accura BLN2110型乳腺定位針。其中20枚為mGGO，73枚為pGGO。GGNs病灶直徑0.29~2.6cm，平均直徑0.88cm。病灶距胸膜下0.29~4.6cm，平均距離1.5cm。病灶大部分位于肺實(shí)質(zhì)的外周，24例位于右肺上葉，10例位于右肺中葉，23例位于右肺下葉，18例位于左肺上葉，18例位于左肺下葉。測量93枚GGNs病變距胸膜下的距離（X）與定位針偏離病灶中心的距離（Y），對兩組數(shù)據(jù)進(jìn)行線性相關(guān)分析。 結(jié)果：81名患者共93枚GGNs均定位成功。術(shù)后病理，19枚為良性結(jié)節(jié)，74枚為惡性腫瘤。其中，74枚為腺癌（10枚為原位癌，25枚為微浸潤腺癌，余39枚為浸潤性腺癌），5枚AAH為癌前期病變，2枚錯構(gòu)瘤為良性腫瘤，12枚為炎癥.81名患者中44例出現(xiàn)不同量的氣胸，但均無需胸腔閉式引流等特殊處理。兩名患者的兩枚GGNs定位中出現(xiàn)定位針脫離的情況，但術(shù)中均根據(jù)定位針出血點(diǎn)完成胸腔鏡微創(chuàng)病灶楔形切除術(shù)。分別對X、Y、XY、X2與Y2進(jìn)行制表，并繪制散點(diǎn)圖，得出X與Y呈直線趨勢。對X與Y兩組數(shù)據(jù)作pearson雙變量相關(guān)分析，得出X與Y呈正線性相關(guān)（r=0.333，，p＜0.05）。 結(jié)論：肺內(nèi)磨玻璃樣結(jié)節(jié)病灶經(jīng)CT引導(dǎo)下Hook-wire定位并行胸腔鏡微創(chuàng)楔形切除術(shù)是一種安全、有效的診斷治療方法，能夠明顯提高早期肺癌的診治率。充分的術(shù)前準(zhǔn)備、規(guī)范的手術(shù)操作是手術(shù)定位成功的關(guān)鍵。GGNs病變距胸膜下的距離與Hook-wire定位針偏離病灶中心的距離存在一定的正相關(guān)性，病灶距胸膜越遠(yuǎn)者定位針偏離病灶的可能性也越大。我們認(rèn)為距離胸膜下≤3cm的病灶更適合進(jìn)行胸腔鏡術(shù)前CT引導(dǎo)下Hook-wire定位。
[Abstract]:Objective: to retrospectively analyze the clinical application of ground-glass nodules (GGNs) Hook-wire localization under the guidance of CT before thoracoscopy, and summarize the experience of operation, and analyze the relationship between the depth of GGNs distance from pleura and the deviation error of GGNs needle. To discuss the indication and standard operation of Hook-wire localization under CT guidance. Materials and methods: CT-guided Hook-wire localization was performed on 93 GGNs specimens from 81 patients with pulmonary diseases, including 28 males and 53 females, aged 2477 years with an average age of 58 years. Then the thoracoscopic minimally invasive wedge resection. Ct scanner was performed with GE Lightspeed16 helical CT.The localization needles were all made of Accura BLN2110 type breast localization needles of Angiotech Company, 20 of which were pGGO.GGNs lesions with an average diameter of 0.88 cm (0.29C 2.6cm). The mean distance from the lesion to the subpleural area was 0.29 鹵4.6 cm, with an average distance of 1.5 cm. Most of the lesions were located in the periphery of the pulmonary parenchyma in 24 cases, located in the superior lobe of the right lung in 10 cases, in the middle lobe of the right lung in 23 cases, in the inferior lobe of the right lung in 18 cases, in the superior lobe of the left lung in 18 cases, in the left lower lobe of the lung. 93 GGNs were measured. The distance from the lesion to the subpleural area (X) and the distance between the needle and the center of the lesion were analyzed by linear correlation analysis. Results all 93 GGNs were successfully located in 81 patients. 19 cases were benign nodules and 74 cases were malignant tumors, of which 74 cases were adenocarcinoma and 10 cases were carcinoma in situ. 25 cases were microinfiltrated adenocarcinoma. In the remaining 39 cases, 5 AAH were precancerous lesions, 2 hamartomas were benign tumors, 12 were benign tumors, and 44 patients had different amounts of pneumothorax. However, there was no need for special treatment such as closed thoracic drainage. The two patients were separated from the localization needle in two GGNs localizations, but all of them underwent minimally invasive thoracoscopic wedge resection according to the bleeding point of the fixed needle during the operation. The pearson bivariate correlation analysis of X and Y data shows that X and Y have a positive linear correlation with X and Y, and the linear correlation between X and Y is 0.333 (p < 0.05). Conclusion: Hook-wire guided by CT and minimally invasive wedge resection under thoracoscopy is a safe and effective method for diagnosis and treatment of early lung cancer, and can improve the diagnosis and treatment rate of early lung cancer. Standard operation is the key to successful localization. There is a positive correlation between the distance from the lesion to the subpleural cavity and the distance from the center of the lesion by Hook-wire. The more distant the focus from the pleura, the more likely the needle to deviate from the focus. We think that the lesion 鈮

本文編號：1576125