对比医用胶与Hook-wire在肺小结节胸腔镜下肺组织切除术前定位中的应用
|
摘要
目的对比医用胶与Hook-wire在肺小结节(最大径≤30mm)胸腔镜下肺组织切除术前定位中的应用价值。方法回顾性分析107例接受胸腔镜下肺楔形切除、肺段或肺叶切除术的肺小结节患者的资料。按术前定位方法分为医用胶组(88例,共90个结节)及Hook-wire组(19例,共19个结节),比较2组病灶位置、结节大小、结节与胸膜的距离、结节良恶性、胸腔镜手术方式及并发症(包括气胸、肺出血、局部疼痛、咳嗽)的差异,并对并发症的相关危险因素进行二元Logistic回归分析。结果 2组病灶位置、结节大小、结节与胸膜的距离、结节良恶性及胸腔镜手术方式差异均无统计学意义(P均>0.05),术前定位成功率均为100%。医用胶组总体并发症发生率及肺出血发生率均明显低于Hook-wire组(P均<0.01)。定位方法为总体并发症、肺出血、局部疼痛的独立危险因子,结节到胸膜的距离为肺出血的独立危险因子。结论医用胶可用于肺小结节胸腔镜下肺组织切除术前定位,且相对于Hook-wire定位并发症发生率更低。
Objective To compare the application value between medical adhesive and Hook-wire in pre-thoracoscopy localization of small pulmonary nodules(≤ 30mm).Methods Data of 107 patients with small pulmonary nodules who underwent thoracoscopic wedge resection,segmental or lobectomy were retrospectively analyzed.The patients were divided into medical adhesive group(88cases with 90nodules)and Hook-wire group(19cases with 19nodules)according to prethoracoscopy localization method.The location of lesion,nodule size,distance between nodule and pleura,nature of nodule(benign or malignant),surgery method and complications(including pneumothorax,pulmonary hemorrhage,pain and cough)were compared between the two groups.Binary Logistic regression analysis was performed to determine the complications' related risk factors.Results There was no significant difference of the location of lesion,nodules size,distance between nodule and pleura,nature of nodule nor the method of thoracoscopic surgery between the two groups(all P>0.05).The pre-thoracoscopy localization success rate of both two groups were 100%.The overall complication rate and the incidence of pulmonary hemorrhage in medical adhesive group were significantly lower than those in Hook-wire group(both P<0.01).The localization method was an independent risk factor for complications after pre-thoracoscopy localization,pulmonary hemorrhage and chest pain,while the distance from the nodule to pleura was an independent risk factor for pulmonary hemorrhage.Conclusion Medical adhesive can be used for pre-thoracoscopy localization of small pulmonary nodule with lower complication rate compared with Hook-wire.
Objective To compare the application value between medical adhesive and Hook-wire in pre-thoracoscopy localization of small pulmonary nodules(≤ 30mm).Methods Data of 107 patients with small pulmonary nodules who underwent thoracoscopic wedge resection,segmental or lobectomy were retrospectively analyzed.The patients were divided into medical adhesive group(88cases with 90nodules)and Hook-wire group(19cases with 19nodules)according to prethoracoscopy localization method.The location of lesion,nodule size,distance between nodule and pleura,nature of nodule(benign or malignant),surgery method and complications(including pneumothorax,pulmonary hemorrhage,pain and cough)were compared between the two groups.Binary Logistic regression analysis was performed to determine the complications' related risk factors.Results There was no significant difference of the location of lesion,nodules size,distance between nodule and pleura,nature of nodule nor the method of thoracoscopic surgery between the two groups(all P>0.05).The pre-thoracoscopy localization success rate of both two groups were 100%.The overall complication rate and the incidence of pulmonary hemorrhage in medical adhesive group were significantly lower than those in Hook-wire group(both P<0.01).The localization method was an independent risk factor for complications after pre-thoracoscopy localization,pulmonary hemorrhage and chest pain,while the distance from the nodule to pleura was an independent risk factor for pulmonary hemorrhage.Conclusion Medical adhesive can be used for pre-thoracoscopy localization of small pulmonary nodule with lower complication rate compared with Hook-wire.
引文
[1] Kim KS,Beck KS,Lee KY,et al.CT localization for a patient with a ground-glass opacity pulmonary nodule expecting thoracoscopy:A mixture of lipiodol and India ink.J Thorac Dis,2017,9(4):E349-E353.
[2] Chen X, Wang S, Hao Z,et al. Wiremissing:A rare presentation of preoperative localization wire system dislocation.J Cardiothorac Surg,2014,9:162.
[3] Lin MW, Chen JS.Image-guided techniques for localizing pulmonary nodules in thoracoscopic surgery.J Thorac Dis,2016,8(Suppl 9):S749-S755.
[4] Yang SM,Ko WC,Lin MW,et al.Image-guided thoracoscopic surgery with dye localization in a hybrid operating room.J Thorac Dis,2016,8(Suppl 9):S681-S689.
[5]陈志明,吕梁,彭俊,等.胸腔镜术前CT引导下双弹簧圈标记定位孤立性肺结节.中国介入影像与治疗学,2016,13(7):402-405.
[6]刘卓,马婧,洪楠,等.双能量CT联合金属伪影削减算法显示微弹簧圈定位肺结节.中国医学影像技术,2018,34(2):302-305.
[7] Hanauer M,Perentes JY, Krueger T,et al.Pre-operative localization of solitary pulmonary nodules with computed tomography-guided hook wire:Report of 181 patients. J Cardiothorac Surg,2016,11:5.
[8] Zhong Y,Xu XQ,Pan XL,et al.Retrospective evaluation of safety,efficacy and risk factors for pneumothorax in simultaneous localizations of multiple pulmonary nodules using hook wire system.Cardiovasc Intervent Radiol,2017,40(9):1408-1414.
[9]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.中华放射学杂志,2010,44(5):518-522.
[10] Seo JM,Lee HY, Hong KK,et al.Factors determining successful computed tomography-guided localization of lung nodules.J Thorac Cardiovasc Surg,2012,143(4):809-814.
[11]范庆浩,吴晓明,汪军峰,等.肺小结节胸腔镜术前CT引导硬化剂定位的临床比较研究.中国现代医生,2017,55(18):16-19,23.
[12]邱宁雷,张治,庄一平,等.肺部小结节胸腔镜术前CT引导下硬化剂定位的临床应用价值.中华胸心血管外科杂志,2012,28(7):398-400.
[2] Chen X, Wang S, Hao Z,et al. Wiremissing:A rare presentation of preoperative localization wire system dislocation.J Cardiothorac Surg,2014,9:162.
[3] Lin MW, Chen JS.Image-guided techniques for localizing pulmonary nodules in thoracoscopic surgery.J Thorac Dis,2016,8(Suppl 9):S749-S755.
[4] Yang SM,Ko WC,Lin MW,et al.Image-guided thoracoscopic surgery with dye localization in a hybrid operating room.J Thorac Dis,2016,8(Suppl 9):S681-S689.
[5]陈志明,吕梁,彭俊,等.胸腔镜术前CT引导下双弹簧圈标记定位孤立性肺结节.中国介入影像与治疗学,2016,13(7):402-405.
[6]刘卓,马婧,洪楠,等.双能量CT联合金属伪影削减算法显示微弹簧圈定位肺结节.中国医学影像技术,2018,34(2):302-305.
[7] Hanauer M,Perentes JY, Krueger T,et al.Pre-operative localization of solitary pulmonary nodules with computed tomography-guided hook wire:Report of 181 patients. J Cardiothorac Surg,2016,11:5.
[8] Zhong Y,Xu XQ,Pan XL,et al.Retrospective evaluation of safety,efficacy and risk factors for pneumothorax in simultaneous localizations of multiple pulmonary nodules using hook wire system.Cardiovasc Intervent Radiol,2017,40(9):1408-1414.
[9]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.中华放射学杂志,2010,44(5):518-522.
[10] Seo JM,Lee HY, Hong KK,et al.Factors determining successful computed tomography-guided localization of lung nodules.J Thorac Cardiovasc Surg,2012,143(4):809-814.
[11]范庆浩,吴晓明,汪军峰,等.肺小结节胸腔镜术前CT引导硬化剂定位的临床比较研究.中国现代医生,2017,55(18):16-19,23.
[12]邱宁雷,张治,庄一平,等.肺部小结节胸腔镜术前CT引导下硬化剂定位的临床应用价值.中华胸心血管外科杂志,2012,28(7):398-400.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |