摘要目的 探讨CT引导下亚甲蓝与Hookwire联合定位在胸腔镜下孤立性肺小结节(SPN)切除术中的临床应用价值.方法 对56例患者的60枚SPN术前行CT引导下亚甲蓝与Hookwire联合定位后行胸腔镜(VATS)肺楔形切除术.全组患者男19例,女37例；年龄35～81岁,平均(61.1±8.9)岁.结果 56例60枚SPN直径为(6.80±4.12) mm,距壁层胸膜(15.38±4.63) mm.CT引导下定位成功率100％,定位时间(10.76±8.17) min.定位后5例(8.9％)发生局部少量气胸,4例(7.1％)发生肺出血,均无需治疗.60枚肺小结节病灶均准确定位,VATS楔形切除术成功率100％.术后病理显示,肺泡细胞癌(BAC)33枚(55.0％),肺泡细胞癌伴腺癌(BAC+ AC) 11枚(18.3％),肺泡细胞不典型增生(AAH)7枚(ll.8％),炎性肉芽肿4枚(6.7％),错构瘤3枚(5.0％),结核性肉芽肿2枚(3.3％).结论 胸腔镜术前CT引导下亚甲蓝与Hookwire联合定位准确率高,对胸腔镜手术(VATS)楔形切除病灶有极大的帮助作用,具有良好的临床应用价值.

abstractsObjective To evaluate the clinical application of CT-guided localization with combination of methylene blue and a Hookwire system for small pulmonary nodules (SPNs) before video-assisted thoracoscopic resection.Methods CTguided localization the SPNs before resection in 56 patients and 60 nodules,then underwent video-assisted thoracic surgery (VATS) resection.Among 56 patients,19 males and 37 females,aged from 35 to 81 years,mean age was (61.1 ±8.9)years.Results SPNs diameter (6.80 ±4.12) mm,distance from the parietal pleura (15.38 ±4.63) mm.CT-guided localization success rate was 100％,positioning time (10.76 ± 8.17) min,8.9％ (5/56) had micro pneumothorax aftet positioning,7.1％ (4/56) occurrence of needle tract bleeding,no conservative treatment.VATS resection rate was 100％.The pathology of 60 lesions were shown:Bronchiolo-alveolar carcinoma(BAC) were 33 lesions(55.0％),BAC and adenocarcinoma were 11 lesions(18.3％),Atypicaladenomatous hyperplasia (AAH) were 7 lesions (11.8％),Inflammation were 4 lesions (6.7％),Harmatoma were 3 lesions(5.0％),Tuberculoses were 2 lesions(3.3％).Conclusion CT-guided localization with combination of methylene blue and a Hookwire system before video-assisted thoracoscopic resection is a promising technique for small solitary pulmonary nodules.It could play an important role in accurate localization of small pulmonary nodules,and it is a safe technique with clinical application.