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Title: [Computed Tomography Guided Hook-wire Precise Localization and Minimally Invasive Resection of Pulmonary Nodules].
Author: Wang T, Ma S, Yan T, Song J, Wang K, He W, Bai J.
Journal: Zhongguo Fei Ai Za Zhi; 2015 Nov; 18(11):680-5. PubMed ID: 26582223.
Abstract:
BACKGROUND AND OBJECTIVE: Localization of pulmonary ground glass nodule is the technical difficulty of minimally invasive operation resection. The aim of this study is to evaluate the value of computed tomography (CT)-guided Hook-wire precise localization in resection of pulmonary nodules by video-assisted thoracoscopic surgery (VATS) as well as to discuss the necessity and feasibility of surgical resection of GGOs through a minimally invasive approach. METHODS: CT-guided Hook-wire precise localization and wedge resection was done on 25 cases with 26 pulmonary nodules by VATS from May 2013 to June 2015. The efficacy of localization was evaluated in terms of procedure time, VATS success rate, and associated complications of localization. RESULTS: All the 26 pulmonary nodules (6 solid nodules and 20 GGOs ) of 25 patients (10 males and 15 females) were preoperatively detected and localized with Hook-wire under CT guidance. Nodule diameters ranged from 5 mm-20 mm (mean: 8 mm). The distance of lung lesions from the nearest pleural surfaces ranged within 5 mm-30 mm (mean: 14 mm). All resections of lesions guided by the Hook-wire were successfully performed by VATS (success rate: 100%). The mean procedure time for the CT-guided Hook-wire localization was 10 min (range: 5 min-10 min). The mean procedure time for VATS wedge resection was 20 min (range: 15 min-40 min). The mean hospital time was 4 d (range: 3 d-6 d). The major complication of CT-guided Hook-wire localization was mild pneumothorax in 4 patients, but no one needed chest tube drainage. Wedge resection was performed successfully in all cases. The dislocation of Hook-wire was found in only one patient during the operation, but the lesion was still successfully resected under VATS. Results of pathological examination of 16 mGGOs revealed 8 primary lung cancers and 8 nonspecific chronic inflammations. Results of pathological examination of 4 pGGOs revealed 1 primary lung cancers, 1 atypical adenomatous hyperplasia (AAH), and 2 nonspecific chronic inflammations. CONCLUSIONS: The preoperative CT-guided Hook-wire localization for pulmonary nodules particularly for GGOs is an effective and safe technique to assist VATS resection of the nodules. It can increase the ratio of lung wedge resection with little complications and may be better used in clinical diagnosis and treatment of small pulmonary nodules with VATS. Lung mGGOs carry a high risk of malignancy. Aggressive surgical resection of these mGGOs is necessary and feasible. 背景与目的肺小结节尤其是磨玻璃结节（ground glass opacity, GGO）病灶的定位是微创手术切除的难点，报道的方法很多但均有不足。本研究旨在探讨计算机断层扫描（computed tomography, CT）引导下Hook-wire术前定位在胸腔镜下（video-assisted thoracoscopic surgery, VATS）肺结节切除术中的临床应用价值，并初步探讨GGOs积极微创手术治疗的必要性和可行性。方法 2013年5月-2015年6月共25例患者的26枚肺结节于术前行CT引导下Hook-wire定位，然后施行胸腔镜楔形切除术。统计Hook-wire定位时间、成功率、并发症及楔形切除时间、住院时间等，计算病灶组织学分型中的恶性几率，讨论肺部GGOs积极手术治疗的必要性。结果共25例患者26个结节（男性10例，女性15例，6个实性结节，20个GGOs），病灶直径5 mm-20 mm（平均8 mm），病灶距离胸膜垂直距离5 mm-30 mm（平均14 mm），CT引导下Hook-wire定位成功率为100%。VATS楔形切除术成功率为100%。CT定位时间平均10 min（5 min-15 min），微创切除病灶所需时间平均20 min（15 min-40 min），平均住院时间为4 d（3 d-6 d）。4例患者定位后发生微量气胸，但无需闭式引流处理。术中定位针脱落1例，但仍于胸腔镜下观察到穿刺点脏层胸膜下血肿后，准确定位并成功切除。20个GGOs术后组织学诊断结果为：16个混合性GGOs（mixed GGO, mGGO）中，微浸润腺癌2例，腺癌5例，小细胞肺癌（small cell lung cancer, SCLC）1例，炎性病灶8例；4个纯GGOs（pure GGO, pGGO）中原位腺癌1例，非典型性腺瘤样增生（atypical adenomatoid hyperplasia, AAH）1例，炎性病灶2例。结论 CT引导下Hook-wire肺结节尤其是GGOs术前定位准确率高，相关并发症轻微，是一种安全、有效的方法，能快速确定下一步诊疗方案，值得临床推广；肺部mGGOs是恶性病灶的几率很大，积极微创手术治疗是非常必要的。.

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