李林　　何良勇　　张丹

[摘要] 目的 探讨肺部小结节胸腔镜手术中CT引导下Hook-wire穿刺定位的应用。 方法 回顾性选取2018年7月至2019年7月本院60例肺部小结节患者，按照治疗方法分为对照组与观察组，每组各30例。对照组采取术中手指触摸肺部结节定位，观察组于术前在CT引导下行Hook-wire穿刺定位，兩组均行胸腔镜下肺楔形切除术，若切除的肺组织未见结节，则改行胸腔镜下肺叶切除，统计两组患者胸腔镜手术持续时间、术中出血量、住院时间及费用、切除肺组织结节阴性及中转肺叶切除情况、出血、气胸发生情况。 结果 观察组患者的手术持续时间为（40.3±10.4）min，显著短于对照组的（60.8±10.2）min（P<0.05）;术中出血量为（5.6±1.4）mL，显著少于对照组的（16.2±2.5）mL（P<0.05）;住院时间为（5.8±1.0）d，显著短于对照组的（7.9±1.3）d（P<0.05）;住院费用为（3.0±1.0）万元，显著低于对照组的（3.6±0.4）万元（P<0.05）。观察组患者的切除肺组织结节阴性及中转肺叶切除率（3.3%）显著低于对照组（16.7%）（P<0.05）;但两组患者的出血、气胸发生率（3.3%、6.7% vs. 0、0）比较，差异无统计学意义（P>0.05）。 结论 肺部小结节胸腔镜手术中术前在CT引导下Hook-wire穿刺定位的应用效果较术中手指触摸肺部结节定位好。

[关键词] 肺部小结节;胸腔镜手术;CT引导下Hook-wire穿刺定位;切除肺组织结节阴性及中转肺叶切除

[中图分类号] R734.2          [文献标识码] B          [文章编号] 1673-9701（2021）13-0062-03

Application of CT-guided Hook-wire puncture positioning for pulmonary nodules in thoracoscopic surgery

LI Lin1 HE Liangyong1   ZHANG Dan2

1.Department of Cardiothoracic Surgery， Ji′an Central Hospital in Jiangxi Province， Ji′an   343000， China; 2.Department of Critical Care Medicine， Ji′an Central Hospital in Jiangxi Province， Ji′an   343000， China

[Abstract] Objective To explore the application of CT-guided Hook-wire puncture positioning for pulmonary nodules in thoracoscopic surgery. Methods Sixty patients with small pulmonary nodules in our hospital from July 2018 to July 2019 were selected retrospectively. According to the treatment methods， they were divided into the control group and the observation group， with 30 cases in each group. In the control group， lung nodules were touched by fingers to locate during operation， while in the observation group， Hook-wire puncture was used to locate lung nodules under the guidance of CT before operation. Both groups underwent thoracoscopic pulmonary wedge resection. If no nodules were found in the resected lung tissues， thoracoscopic lobectomy was performed instead. The duration of thoracoscopic surgery， intraoperative blood loss， hospitalization time and cost， negative pulmonary nodule resection and the transfer to lobectomy， bleeding and pneumothorax were observed and compared between the two groups. Results The duration of operation in the observation group was significantly shorter than that in the control group[（40.3±10.4）min vs. （60.8±10.2）min] （P<0.05）. The amount of intraoperative blood loss was（5.6±1.4） mL in the observation group， which was significantly less than that of the control group （16.2±2.5） mL（P<0.05）.The hospitalization stay of （5.8±1.0） days in the observation group was significantly shorter than（7.9±1.3） days of the control group （P<0.05）， and the cost of hospitalization of （3.0±1.0） ten thousand yuan was significantly lower than （3.6±0.4） ten thousand yuan of the control group （P<0.05）. The rate of negative resected lung nodules and transferred lobectomy in the observation group was 3.3%，which was significantly lower than that in the control group（16.7%， P<0.05）. However，there was no significant difference between the two groups in the incidence of bleeding and pneumothorax （3.3%， 6.7% vs 0、0） （P>0.05）. Conclusion Hook-wire puncture positioning under CT guidance is better than finger touching in lung nodules positioning during thoracoscopic surgery.

[Key words] Small pulmonary nodules; Thoracoscopic surgery; Hook-wire puncture positioning under CT guidance; Negative nodule in resected lung tissue and conversion to lobectomy

隨着低剂量螺旋CT检查的普及，越来越多的孤立性周围型肺部微小结节（直径0.5～1.0 cm）被发现[1]，但应用PET-CT或经皮穿刺活检等技术，准确诊断肺部结节仍面临巨大困难，而胸腔镜手术在肺部小结节的病理诊断和切除方面发挥至关重要的作用[2]。但胸腔镜手术由于其操作的局限性，准确定位成为胸腔镜诊治肺部小结节的关键，开展CT引导下经皮Hook-wire定位在胸腔镜手术切除肺部小结节中的应用十分必要[3]。目前国内外胸外科领域已有多种胸腔镜术前肺部结节定位技术，常见的有经皮Hook-wire穿刺定位法、经皮穿刺碘油染色法、经皮肺表面美蓝染色法、经皮穿刺弹簧圈植入法等，其中经皮Hook-wire穿刺定位法技术设备要求低、操作简便、定位准确，值得推广。……