动脉流域分析定位法在胸腔镜肺楔形切除术中的应用

周少; 朱潇; 杏福宝; 王伟; 宋超; 李小军; 唐震; 张雷

doi:10.16766/j.cnki.issn.1674-4152.003323

动脉流域分析定位法在胸腔镜肺楔形切除术中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003323

蚌埠医科大学第一附属医院胸外科，安徽蚌埠 233004

基金项目:

安徽省教育厅重点项目 KJ2019A0340

蚌埠医学院自然重点项目 2022byzd066

蚌埠医学院重点项目 2021byzd075

详细信息

通讯作者:
张雷，E-mail：13855282388@139.com

中图分类号: R655.3
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出版历程
- 收稿日期: 2023-08-29
- 网络出版日期: 2024-03-09

Application effect of watershed analysis of the target pulmonary artery method in thoracoscopic wedge resection of the lung

Department of Cardiothoracic Surgery, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨在胸腔镜肺楔形切除术中应用动脉流域分析定位法定位肺磨玻璃结节的可行性和安全性。方法选取2021年11月—2023年7月蚌埠医科大学第一附属医院胸外科收治的146例胸腔镜肺楔形切除术患者为研究对象，采用随机数字表法将其分为对照组(73例, 传统CT扫描弹簧圈定位)和观察组(73例, 动脉流域分析定位)，比较2组患者的定位效果。结果对照组中有5例患者因结节位置特殊经安全评估后不宜行CT扫描定位，转入观察组行动脉流域分析定位。观察组的住院费用[(24 808.66±1 762.28)元]低于对照组[(25 776.73±1 723.93)元]，差异有统计学意义(t=3.350，P＜0.05)；观察组围手术期并发症发生率为7.69%(6/78)，低于对照组, 差异有统计学意义[26.47%(18/68), χ²=9.326，P＜0.05]；观察组首次切除成功率[94.87%(74/78)]高于对照组[83.82%(57/68)]，差异有统计学意义(χ²=4.810, P＜0.05)。2组的定位时间、术中出血量、术后第1天引流量、拔管时间及病理类型比较，差异均无统计学意义(P＞0.05)。结论动脉流域分析定位法是一种有潜力的新型肺结节定位方法，可以有效保证安全手术切缘，提高结节首次切除成功率，降低患者住院费用和围手术期并发症发生率，且定位简单，尤其适用于特殊位置的肺结节，便于患者接受，值得临床推广应用。
- 动脉流域分析定位法 /
- 胸腔镜肺楔形切除术 /
- 肺磨玻璃结节 /
- 定位
Abstract: Objective To evaluate the feasibility and safety of using arterial watershed analysis in the localization of pulmonary ground glass nodules during thoracoscopic wedge resection. Methods A total of 146 patients with thoracoscopic wedge resection admitted to the Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical University from November 2021 to July 2023 were selected as research subjects, and the patients were divided into control group (n=73, traditional CT scan coil positioning) and observation group (n=73, identified by arterial watershed analysis) by random number table method. The localization effects of the two groups were compared. Results In the control group, 5 patients were not suitable for CT scan localization due to the special location of nodules after safety evaluation by physicians, and they were transferred to the observation group and successfully localized by watershed analysis of the artery. The hospitalization cost of the observation group [(24 808.66±1 762.28) yuan] was lower than that of the control group [(25 776.73±1 723.93 yuan), t=3.350, P < 0.05]. The incidence of perioperative complications in the observation group was 7.69% (6/78), which was lower than 26.47% (18/68) in the control group (χ²=9.326, P < 0.05). The success rate of first resection in the observation group was 94.87% (74/78), which was higher than 83.82% (57/68) in the control group (χ²=4.810, P < 0.05). There was no significant difference in positioning time, intraoperative blood loss, drainage volume on the first day after surgery, extubation time and pathological type data between the two groups (P>0.05). Conclusion The watershed analysis of artery localization method is a potential new localization method for pulmonary nodules, which can effectively ensure the safe surgical margin, improve the success rate of nodule resection at the first time, reduce the hospitalization cost and the incidence of perioperative complications, and the localization is simple, especially suitable for pulmonary nodules in special locations. It is easily accepted by patients and worthy of clinical application.
- Watershed analysis of the artery /
- Pulmonary wedge resection /
- Ground glass nodule /
- Location

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图 1 CT引导下肺结节弹簧圈定位图

注：A为定位前CT扫描确定结节位置，设计穿刺深度和角度；B为导引针穿刺至结节附近位置；C为退出导引针将弹簧圈成功释放并定位至结节附近；D为术中所见弹簧圈定位于肺内。

Figure 1. CT-Guided Coil localization image for pulmonary nodules

下载: 全尺寸图片幻灯片

图 2 动脉流域分析定位法定位图

注：A为高分辨CT明确结节位置及设计平面切缘；B为利用mimics软件重建支气管和动脉血管并设计结节安全切缘球，明确切缘内流域动脉；C为术中解剖分离靶组织流域动脉并临时阻断；D为外周静脉注射吲哚菁绿后在荧光胸腔镜下观察靶组织界限并标记。

Figure 2. Watershed analysis of the artery localization image for pulmonary nodules

下载: 全尺寸图片幻灯片

表 1 2组胸腔镜肺楔形切除术患者围手术期定量指标比较

Table 1. Comparison of perioperative quantitative parameters in the two groups of patients

组别	例数	定位时间(x±s，min)	术中出血量(x±s，mL)	术后第1天引流量[M(P₂₅, P₇₅)，mL]	胸管留置时间(x±s，h)	住院费用(x±s，元)
对照组	68	17.08±2.35	90.40±18.21	112.00(80.75，143.75)	54.16±11.90	25 776.73±1 723.93
观察组	78	16.79±7.34	96.54±29.46	104.50(76.75，145.25)	53.74±12.14	24 808.66±1 762.28
统计量		0.323^a	1.535^a	2 529.000^b	0.213^a	3.350^a
P值		0.747	0.127	0.629	0.832	0.001
注：^a为t值，^b为U值。

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表 2 2组胸腔镜肺楔形切除术患者首次切除成功率及围手术期并发症发生率比较[例(%)]

Table 2. Comparison of initial resection success rate and perioperative complication incidence in the two groups of patients[cases (%)]

组别	例数	首次切除成功	发生围手术期并发症
对照组	68	57(83.82)	18(26.47)
观察组	78	74(94.87)	6(7.69)
χ²值		4.810	9.326
P值		0.028	0.002

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表 3 2组胸腔镜肺楔形切除术患者术前定位相关并发症发生情况[例(%)]

Table 3. The preoperative localization related complications of the two groups of patients with thoracoscopic wedge resection were analyzed[cases (%)]

组别	例数	疼痛	气胸	肺内出血	定位材料移位或脱落	合计
对照组	68	11(16.18)	2(2.94)	2(2.94)	1(1.47)	16(23.53)
观察组	78	0	0	0	0	0

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表 4 2组胸腔镜肺楔形切除术患者术后定位相关并发症发生情况[例(%)]

Table 4. Incidence of localization related complications after thoracoscopic wedge resection in the two groups[cases (%)]

组别	例数	术后漏气	术后出血	合计
对照组	68	2(2.94)	0	2(2.94)
观察组	78	4(5.13)	2(2.56)	6(7.69)

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表 5 2组胸腔镜肺楔形切除术患者病理分布情况比较[例(%)]

Table 5. Comparison of pathological distribution in the two groups of patients[cases (%)]

组别	例数	良性肿瘤	非典型腺瘤样增生	原位腺癌	微浸润腺癌	合计
对照组	68	2(2.94)	14(20.59)	23(33.82)	29(42.65)	68(100.00)
观察组	78	3(3.85)	18(23.08)	25(32.05)	32(41.03)	78(100.00)
注：2组病理分布情况比较，χ²=0.247, P=0.970。

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