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1、术前CT引导Hookwire穿刺联合亚甲蓝染色定位在胸腔镜治疗孤立性肺结节病变的应用许剑扬李建新赵志龙薛洪省(大连大学附属屮山医院胸外科116001)【摘要】R的：探讨术前CT引导Hookwire穿刺联合亚甲蓝染色定位在胸腔镜治疗孤立性肺结节病变的临床价值。方法:我院92例共108枚孤立性肺结节,行术前CT引导Hookwire穿刺联合亚甲蓝染色定位，后行胸腔镜卜*楔形切除术。若为原发性肺癌，行肺叶切除术加系统性淋巴结淸扫术。统计穿刺定位时间、并发症、肺楔形切除术时间、出血量等。结果:穿刺定位时间10-25min,平均14min,气胸(18/92),胸膜反应(3/92),少量咯血(4/92)
2、，肺楔形切除时间5-20min,平均lOmin,出血量5-20ml。结论:CT引导Hookwire穿刺联合亚甲蓝染色定位可提高VATS下SPNs切除的成功率，并发症少，经济方便，在临床有很大的应用价值。【关键词】孤立性肺结节术前定位Hookwire胸腔镜切除术【中图分类号】R563【文献标识码】A【文章编号】1672-5085(2014)08-0185-02PreoperativeCT-guidedbiopsycombinedmethylenebluestainingHookwirepositionedthoracoscopictreatmentofsolitarypulmonarynod
3、ulesapplicationsXuJian-yang,LiJian-xin,ZhaoZhi-long,XueHong-shengDepartmentofThoracicSurgery,ZhongshanHospital,DalianUniversity,Dalian116001,China.【Abstract】ObjectiveToevaluatethepreoperativeCT-guidedbiopsycombinedmethylenebluestainingHookwirepositionedthoracoscopictreatmentofsolitarypulmonarynodu
4、lesclinicalvalue.Methods:92casesinourhospital108metersolitarypulmonarynodules,preoperativeCT-guidedbiopsycombinedmethylenebluestainingHookwirepositioning,underwentthoracoscopicwedgeresection.Forprimarylungcancer,lobectomyplussystematiclymphadenectomy.Statisticspuncturepositioningtime,complications
5、,pulmonarywedgeresectiontime,bloodlossandsoon.Theresultspuncturepositioningtime10-25min,anaverageof14min,pneumothorax(18/92),pleuralreaction(3/92),asmallamountofhemoptysis(4/92),pulmonarywedgeresectiontime5-20min,anaverageoflOmin,bleeding5-20ml.ConclusionCT-guidedbiopsycombinedmethylenebluestainin
6、gHookwirepositionedunderVATSSPNsresectionmayimprovethesuccessrate,fewercomplications,economical,convenient,greatclinicalvalue.【Keywords】solitarypulmonarynodulesPreoperativelocalizationHookwireThoracoscopicresection随着高分辨率CT的普及应用，越来越多的孤立性肺结节(solitarypulmonarynodules,SPNs)被筛查出来。AlbertRH等［1］报道，SPNs的发现
7、率可达到8%-15%。0前国内外公认的SPNs定义为肺实质内单发孤立的圆形或类圆形、直径≤3cm，不伴有肺不张、无淋巴结肿大或肺内其他异常的病变。SPNs中恶性肿瘤的比率可达到68%［2］，常为早期肺癌。电视胸腔镜手术(video-assistedthoracicsurgery,VATS)能够完整切除病灶，病理准确率可达到100%［3］，是SPNs诊断的金标准。然而大多数的SPNs术中触摸不到，难以定位，因此急需寻
