肺磨玻璃密度结节胸腔镜术前CT引导下Hook-wire定位的应用研究

发布时间：2018-03-06 19:15

  本文选题：肺内磨玻璃密度结节　切入点：CT引导下定位　出处：《大连医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：回顾分析肺内磨玻璃密度结节（ground-glass nodules, GGNs）胸腔镜术前CT引导下Hook-wire定位的临床应用并总结操作经验。分析GGNs距离胸膜的深度与定位针偏离误差的关系，探讨CT引导下Hook-wire定位术的适应症并规范操作。 资料与方法：对81名肺部病变患者（81名患者中男性28例，女性53例。年龄24~77岁，平均年龄58岁）的93枚肺内GGNs进行CT引导下Hook-wire定位，随后进行胸腔镜微创病灶楔形切除术。CT扫描机采用美国GE Lightspeed16螺旋CT，定位针均采用美国Angiotech公司的Accura BLN2110型乳腺定位针。其中20枚为mGGO，73枚为pGGO。GGNs病灶直径0.29~2.6cm，平均直径0.88cm。病灶距胸膜下0.29~4.6cm，平均距离1.5cm。病灶大部分位于肺实质的外周，24例位于右肺上叶，10例位于右肺中叶，23例位于右肺下叶，18例位于左肺上叶，18例位于左肺下叶。测量93枚GGNs病变距胸膜下的距离（X）与定位针偏离病灶中心的距离（Y），对两组数据进行线性相关分析。 结果：81名患者共93枚GGNs均定位成功。术后病理，19枚为良性结节，74枚为恶性肿瘤。其中，74枚为腺癌（10枚为原位癌，25枚为微浸润腺癌，余39枚为浸润性腺癌），5枚AAH为癌前期病变，2枚错构瘤为良性肿瘤，12枚为炎症.81名患者中44例出现不同量的气胸，但均无需胸腔闭式引流等特殊处理。两名患者的两枚GGNs定位中出现定位针脱离的情况，但术中均根据定位针出血点完成胸腔镜微创病灶楔形切除术。分别对X、Y、XY、X2与Y2进行制表，并绘制散点图，得出X与Y呈直线趋势。对X与Y两组数据作pearson双变量相关分析，得出X与Y呈正线性相关（r=0.333，，p＜0.05）。 结论：肺内磨玻璃样结节病灶经CT引导下Hook-wire定位并行胸腔镜微创楔形切除术是一种安全、有效的诊断治疗方法，能够明显提高早期肺癌的诊治率。充分的术前准备、规范的手术操作是手术定位成功的关键。GGNs病变距胸膜下的距离与Hook-wire定位针偏离病灶中心的距离存在一定的正相关性，病灶距胸膜越远者定位针偏离病灶的可能性也越大。我们认为距离胸膜下≤3cm的病灶更适合进行胸腔镜术前CT引导下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 卤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

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