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经Hook-wire定位切除的肺小结节临床及影像特征(已一审)
The correlations between the clinical characteristcs , imaging features of small pulmonary nodules less than 10mm undergone hook-wire localization and pathology
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DOI:
作者:
冯明恺 徐旋里 周建英
Feng Ming-kai,Xu Xuan-li,Zhou Jian-ying
作者单位:
浙江大学医学院附属第一医院呼吸科,现在诸暨市人民医院呼吸内科工作。
Department of Respiratory Medicine,The First Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou
关键词:
肺小结节;Hook-wire定位;CT引导
Small pulmonary nodule ;Hook-wire localization ;CT-guided
摘要:
目的 探讨经术前CT引导下Hook-wire定位切除的直径≤10mm肺小结节临床及影像特征,并论证Hook-wire的临床应用价值。方法 回顾性分析2010年1月30日至 2013 年11月30日在浙江大学医学院附属第一医院经电视辅助胸腔镜手术(VATS)切除的直径≤10mm的肺小结节81枚,术前均经CT引导下Hook-wire定位,探讨其临床及CT影像特征和病理类型的关系,并论证Hook-wire定位的有效率和安全性。结果 81枚直径≤10mm肺小结节中慢性炎症、不典型腺瘤样增生、癌性结节分别为24枚、27枚、30枚。年龄≥60岁,男性,有吸烟史者恶性率分别为68.75%,46.1%,45.5%(P<0.05);肺小结节边界模糊、有毛刺、有胸膜凹陷、位于肺上叶、直径≥6mm者的恶性率分别为50%、61.9%、60%,48.8%,51.1%,较边缘清晰,无毛刺,无胸膜凹陷,位于中下肺,直径≤6mm者更倾向于恶性(P<0.05);纯GGO、部分实性GGO、实性结节的恶性率分别为42.8%,52.6%,26.8%(P<0.05);81枚肺小结节,定位成功80枚(98.8%),3例患者定位后出现并发症,1例无症状少量血胸,1例轻度疼痛,1例无症状气胸。 结论 经Hook-wire定位切除的直径≤10mm肺小结节中影像上边界模糊、有毛刺、有胸膜凹陷、位于上叶、直径≥6mm者、亚实性结节更倾向于恶性;术前CT引导下Hook-wire定位并发症低,安全性好。
Objective To analyze the correlations between the clinical characteristcs , imaging features of small pulmonary nodules(SPNs) less than 10mm which had undergone preoperative hook-wire localization and pathology , and investigate the efficiency and safety of Hook-wire. Methods We performed retrospective analysis of 81 SPNs less than 10mm underwent CT-guided hook-wire localizatin befrore video-assisted thoracoscopic surgery(VATS) in the First Hospital Affiliated to Zhejiang University School of Medicine from January 1 st , 2010 to November 31 st , 2013. We reviewed the correlations between the clinical characteristcs , imaging features and pathology of 81 SPNs. Results A total of 81 SPNs were evaluated . There were 24 chronic inflammation , 27 atypical adenomatous hyperplasia and 30 cancerous small pulmonary nodules , respectively. The malignant possibility of SPNs which had ambiguous edge ,glitches ,pleural indentation , located in the upper lobe and diameter more than 6mm were 50%、61.9%、60%,48.8%,51.1% , respectively , and tended to be malignant(P<0.05). The malignant rate of pGGO , part-solid nodules and solid nodules were 42.8%,52.6%,26.8% ,respectively(P<0.05). Eighty SPNs( 98.8% ) were localized successfully. One patient had asymptomatic minimal pneumothoraces , one patient had asymptomatic hemothorax , and one patient had mild chest pain . Conlusion SPNs less than 10mm undergo hook-wire localization have imaging features including glitches , ambiguous edge , pleural indentation , locate in the upper lobe and diameter more than 6mm tend to be malignant . Sub-solid nodules are more probably be to malignant than solid nodules . The safety , reliability and the convenience of CT-guided hook-wire localizatin before VATS are acceptable .
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