CT引导下弹簧圈定位结合DSA实时导向VATS精准切除孤立性肺结节的诊疗价值

发布时间：2018-09-11 16:27

【摘要】：目的肺部结节在手术中的定位一直是临床中的难题。文中讨论CT引导下弹簧圈定位结合数字减影血管造影术(digital subtraction angiography,DSA)实时导向电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)精准切除孤立性肺结节(solitary pulmonary nodule,SPN)的诊疗价值。方法收集2011年9月至2014年5月间南京军区南京总医院心胸外科收治的SPN患者82例。患者均于手术当天在CT引导下经皮穿刺,紧贴病灶放置金属弹簧圈定位,随后送入杂交手术室。术中结合DSA实时导向行VATS楔形切除SPN,再根据术中快速病理结果行下一步处理。结果金属弹簧圈定位成功率100%,平均定位时间(15.3±3.2)min,VATS楔形平均切除手术时间(24.2±12.1)min,术后病理结果显示恶性病变45例、良性病变37例,无严重并发症。结论 SPN在术前CT引导下置入弹簧圈标记定位准确率高。结合DSA实时导向行VATS切除可精准切除病灶,并确保切缘距离病灶2 cm以上,达到SPN诊治一体化的目的。
[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 卤3.2) min,VATS wedge-shaped resection time (24.2 卤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.
【作者单位】：南京军区南京总医院心胸外科;南京军区南京总医院医学影像科;
【基金】：国家自然科学基金(81172032)
【分类号】：R816.4;R563

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