Application value of Hook-wire localization under CT guidance before thoracoscopic resection of small pulmonary ground-glass nodules
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摘要:目的
探讨CT引导Hook-wire穿刺定位在胸腔镜下切除肺小磨玻璃结节的应用价值。
方法选取肺部小结节患者136例为研究对象, 均接受胸腔镜切除术。其中80例(观察组)术前采用CT引导Hook-wire穿刺定位，另外56例(对照组)采用CT常规体表定位。比较2组定位准确率、手术切除时间、住院时间、穿刺成功率、穿刺时间、穿刺深度、并发症总发生率以及引流时间。
结果观察组定位准确率高于对照组，差异有统计学意义(P=0.002 8)。观察组手术切除时间、术后引流时间短于对照组，差异有统计学意义(P＜0.001或P＜0.05)。观察组穿刺成功率为93.4%, 高于对照组的72.2%, 差异有统计学意义(P＜0.001)。观察组穿刺深度小于对照组，差异有统计学意义(P＜0.05)。观察组并发症总发生率为12.5%, 低于对照组的19.6%, 差异有统计学意义(P＜0.001)。
结论术前CT引导Hook-wire穿刺定位在胸腔镜下切除肺小磨玻璃结节病灶中安全性较高，可提高定位准确性、穿刺成功率，缩短手术切除时间、术后引流时间，减少并发症的发生，临床应用价值较好。
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关键词:
- CT引导Hook-wire穿刺 /
- 胸腔镜 /
- 肺小磨玻璃结节 /
- 定位准确性
Abstract:ObjectiveTo explore application value of CT-guided Hook-wire puncture localization in thoracoscopic resection of small pulmonary ground-glass nodules.
MethodsA total of 136 patients with pulmonary nodules were selected as study objects, and underwent thoracoscopic resection Among them, 80 cases (observation group) were treated with CT-guided Hook-wire puncture localization before surgery, and other 56 cases (control group) received CT routine body surface localization. The localization accuracy, surgical resection time, length of hospital stay, puncture success rate, puncture time, puncture depth, total incidence of complications and drainage time were compared between the two groups.
ResultsThe positioning accuracy of the observation group was higher than that of the control group (P=0.002 8). The operative resection time and postoperative drainage time in the observation group were significantly shorter than those in the control group (P < 0.001 or P < 0.05). The puncture success rate of the observation group was 93.4%, which was significantly higher than 72.2% of the control group (P < 0.001). The puncture depth in the observation group was significantly lower than that in the control group (P < 0.05). The total incidence of complications in the observation group was 12.5%, which was significantly lower than 19.6% in the control group (P < 0.001).
ConclusionPreoperative CT-guided Hook-wire puncture localization has a high safety in thoracoscopic resection of small pulmonary ground-glass nodules, which can improve positioning accuracy and puncture success rate, shorten surgical resection time and postoperative drainage time, and reduce the occurrence of complications. It has a good clinical application value.
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表 1 2组患者基线资料比较(x±s)
一般资料 分类 观察组(n=80) 对照组(n=56) P 性别 男 50 34 0.833 女 30 22 年龄/岁 46.5±6.9 46.4±6.5 0.458 体质量指数/(kg/m2) 24.5±2.3 24.7±2.6 0.615 结节总数/个 136 97 结节平均数/个 1.7±0.6 1.6±0.5 0.802 病灶直径/mm 11.5±1.1 11.4±1.2 0.853 位置 左上叶 42 26 0.708 左下叶 20 15 右上叶 32 22 右中叶 18 10 右下叶 24 24 
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表 2 2组结节距离和定位准确率比较(x±s)[n(%)]
组别 n 结节总数/个 距脏层胸膜距离/mm 距斜裂或水平裂距离/mm 定位准确 观察组 80 136 3.6±0.5 40.5±5.6 128(94.1)* 对照组 56 97 3.7±0.5 40.3±5.2 83(85.6) 与对照组比较, * P＜0.05。
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表 3 2组穿刺时间、穿刺深度、术后引流时间及住院时间比较(x±s)
组别 n 穿刺时间/min 穿刺深度/mm 术后引流时间/d 住院时间/d 观察组 80 25.6±6.3 24.6±5.9* 2.5±0.4* 9.01±1.02 对照组 56 27.1±4.2 29.2±6.1 3.2±0.2 9.45±1.11 与对照组比较, * P＜0.05。
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