CT-Guided Hook Wire Localization of Tiny Lung Nodules Expedites Thoracoscopic Resection

背景：內視鏡輔助胸腔手術在胸腔外科手術為一個有診斷及治療價值的工具，然而對於深部肺小結節的切除仍有其限制，於是我們評估利用電腦斷層導引定位鉤來輔助胸腔鏡手術的效用，並推薦對於有肺小結節的病人可藉此方法的幫助來進行胸腔鏡手術。方法：八位(四男四女)有肺小結節(小於一公分)的病人，接受術前電腦斷層導引定位鉤定位，之後立即送往手術室進行內視鏡輔助胸腔手術切除含有肺小結節的部分肺葉。結果：所有病人都成功地定位肺小結節並完成內視鏡輔助胸腔手術切除，最後的病理診斷為一位肺癌，一位轉移性甲狀腺癌，一位轉移性乳癌，五位乾酪性肉芽腫病變，平均手術切除時間十分鐘，平均住院日六天，術後病人沒有任何併發症並平順出院。結論：術前電腦斷層導引定位鉤定位肺小結節，技術上可行並可加速內視鏡輔助胸腔手術的進行，它是一個安全可靠的方法。

關鍵字

肺部結節；內視鏡輔助胸腔手術；電腦斷層攝影；定位鉤

並列摘要

Background: Video-assisted thoracic surgery (VATS) has become a useful diagnostic and therapeutic tool for many thoracic surgical problems. However, there is still some potential limitation in the application of this new technology, especially for the excision of small indeterminate pulmonary nodules. We evaluated the efficacy of CT-guided hook wire fixation as a marker for localizing such lesions during thoracoscopic operations. The herein described localization technique has a low complication rate and can be recommended for patients with small lung nodules before VATS surgery. Methods: Eight patients (4 male and 4 female), with lung nodules measuring less than 10 mm on the CT scan, underwent CT guided hook-wire localization preoperatively. Immediately after the wire fixation, the patients were sent to the operation room. During operation, all patients were placed in the lateral decubitus position under double-lumen intubated anesthesia. After localizing the lesion, another two incisions were made close to the lesion. An Wedge resection was performed smoothly without incident, using thoracoscopy and endoscopic staplers. Results: All peripheral and deeply-seated small lung nodules were successfully localized by endoscopy, with the hook wire as a guide, and resected. The final diagnoses included lung cancer (n=1), metastatic thyroid cancer (n=1), metastatic breast cancer (n=1), and caseating granulomas (n=5). The average nodule resection time was only 10 minutes, and average hospital stay was 6 days. All the patients were discharged uneventfully. Conclusions: Preoperative CT-guided wire fixation of peripheral and deeply-seated small lung nodules enhances the localization of the surgical target, which subsequently facilitates and expedites VATS wedge resection. The CT-guided hook wire localization of tiny lung nodules is safe and effective.

並列關鍵字

lung nodule ； video-assisted thoracic surgery ； computed tomography ； hook wire

國際替代計量

CT-Guided Hook Wire Localization of Tiny Lung Nodules Expedites Thoracoscopic Resection

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