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目的探讨低剂量CT(low-dose CT,LDCT)引导下Hook-wire联合亚甲蓝定位在胸腔镜下肺局灶性磨玻璃样病变(focal ground-glass opacity,fGGO)切除术中的临床应用价值。方法 2010年11月～2012年4月对21例单侧fGGO(直径5～17 mm,平均11.5 mm,距壁层胸膜0～28 mm)行胸腔镜肺楔形切除术,术前皆行LDCT引导下Hook-wire定位,并辅以亚甲蓝染色。结果 LDCT引导下Hook-wire联合亚甲蓝定位成功率为100%,定位时间15～28 min,平均21 min。1例术中金属钩脱落,胸腔镜下观察肺组织表面血肿和亚甲蓝染色而成功手术切除;1例亚甲蓝染色失败,但Hook-wire锚定病灶亦成功手术切除。6例(28.6%)发生并发症,其中无症状气胸4例,无症状左上叶出血1例,无症状气胸和右下叶出血1例。VATS手术时间15～43 min,平均22 min;术中出血量23～38 ml,平均31 ml。术后住院5～12 d,平均7 d。fGGO术后病理:原位癌4例,微浸润腺癌3例,肺腺癌1例,不典型腺瘤样增生5例,错构瘤1例,间质性肺炎3例,肺内淋巴结增生2例,炎性肉芽肿2例。结论 LDCT引导下Hook-wire联合亚甲蓝定位fGGO的准确率高,并发症轻微。
Objective To investigate the clinical application of Hook-wire combined with methylene blue localization under focal thoracoscopic focal ground-glass opacity (fGGO) guided by low-dose CT (LDCT) value. Methods From November 2010 to April 2012, 21 patients with unilateral fGGO (diameter 5-17 mm, mean 11.5 mm, parietal pleura 0-28 mm) underwent thoracoscopic wedge resection and guided by LDCT before operation Under the Hook-wire positioning, supplemented by methylene blue staining. Results The success rate of Hook-wire combined with methylene blue localization under LDCT was 100%. The localization time was 15 to 28 minutes with an average of 21 minutes. One case had a metal hook off, a thoracoscopic observation of lung tissue surface hematoma and methylene blue staining and successful surgical resection; 1 case of methylene blue staining failed, but Hook-wire anchored lesions were also successfully resected. Six patients (28.6%) had complications, including 4 asymptomatic pneumothorax, 1 asymptomatic left upper lobe hemorrhage, 1 asymptomatic pneumothorax and right lower lobe hemorrhage. VATS operation time 15 ~ 43 min, an average of 22 min; intraoperative blood loss 23 ~ 38 ml, an average of 31 ml. Postoperative hospital 5 to 12 days, an average of 7 d. Pathology of fGGO: 4 cases of carcinoma in situ, 3 cases of micro-invasive adenocarcinoma, 1 case of lung adenocarcinoma, 5 cases of atypical adenomatous hyperplasia, 1 case of hamartoma, interstitial pneumonia in 3 cases, pulmonary lymph node hyperplasia 2 cases, 2 cases of inflammatory granuloma. Conclusion The accuracy of HGG-guided Hook-wire combined with methylene blue in the localization of fGGO is high and the complication is minor.