CT-guided Hook-wire Localization of Small Peripheral Lung Nodules for Video-assisted Thoracoscopic Surgery (VATS)

以電腦斷層植入定位鉤以利肺部細小結節之胸腔內視鏡切除

饒啟明(Kee-Min Yeow) ； 劉會平(Hui-Ping Liu) ； 謝明儒(Ming-Ju Hsieh)

《中華放射線醫學雜誌》 25卷2期 (2000/04) Pp. 73-77

摘要

利用內視鏡胸腔手術（video-assisted thoracoscopic surgery, VATS）切除肺臟週邊小結節能成功與否要看結節的大小及其離肺膜表面的距離而定。結節太小或離肺部表面太遠就無法利用內視鏡胸腔手術特有的長器械去觸摸到，因此必需利用定位裝置或染料在結節所在的肺表面將它定位出來以利切除。最近有二例只能在電腦斷層肺質呈相方式（lung window）才能看出的小型肺結節（為7 mm及20 mm太小），吾等認為無法由肺表面直接看出或利用器械去觸摸到。因此於內視鏡胸腔手術前一小時利用電腦斷層導引下經皮植入定位鉤將以上小型肺結節標示出來以利外科醫生在手術進行時快速找到結節的位置。患者在扎針時稍感局部不適，此外並沒有發生氣胸或內出血的情形。我們成功的利用內視鏡胸腔手術將這兩顆小型結節做楔形式（wedge resection）切除。術前定位鉤的植入在有限初步的經驗看來應是安全的，它讓外科醫師很快地找到切除的小結節因此可減少手術時間。

關鍵字

肺臟結節 ； 電腦斷層攝影導引 ； 內視鏡胸腔手術

並列摘要

Lung nodules judged too small or too far from the pleural surface to be seen or palpated during video-assisted thoracoscopic surgery (VATS) need to localized with a marking device or stain, in order to assist their identification intra-operatively. We report on two patients with lung nodules measuring between 7 and 20 mm that could only be seen by lung-window display during CT examination. Their intra-operatively identification during VATS was presumed difficult by the surgeon. CT-guided hook-wire localization of the nodules was performed in less than 1 hour prior to VATS. The patients experienced little pain; no pneumothorax or bleeding was noted. The surgeon, using VATS, successfully resected both lung nodules under the guidance of hook-wires without complication. Hook-wire localization of small lung nodules prior to VATS is safe; in enabled accurate resection of small lung nodules during VATS and reduced the operation time.

並列關鍵字

Lung nodule ； Computed tomography (CT) ； Guidance ； video assisted thoracoscopic surgery (VATS)