混合手术室中的图像引导 VATS 有助于亚厘米级不可触及肺结节的早期诊断和同期治疗。

IF 1.6 Q2 SURGERY
Jamie Partlow, Sabrina Thomas, Michael Nicolini, Sarah Greeno, Carsten Schroeder
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引用次数: 0

摘要

目的:随着肺癌筛查的增加,发现肺部微小、无法触及的病灶的情况也在增加。混合手术室(OR)将经皮或支气管内靶点置入与台式计算机断层扫描(CT)和透视引导相结合,提高了定位能力,有助于更准确地诊断和治疗较小、无法触及的肺部结节:在连续 35 个月中,55 名退伍军人接受了 60 次图像引导下的视频辅助胸腔手术,以切除病灶。其中,36%的病例是在肺癌筛查中发现的。所有患者都在混合手术室接受治疗,锥束 CT 扫描技术用于经皮放置平均 1.6 个靶标(55 例)或通过增强导航支气管镜放置靶标(5 例):结果:共切除了66个病灶。结果:共切除 66 个病灶,病灶大小中位数为 8 毫米,四分位数范围为 6 至 14。患者在放射引导下接受了非解剖性切除和淋巴结清扫术。在有指征的情况下,随后进行解剖切除。在总共47例非小细胞肺癌病变中,83%被诊断为IA1或IA2期。中位手术切缘为15毫米;切缘宽度通常是病灶宽度的1.5倍:结论:混合手术室技术能对肺部小病灶进行三维评估,在实现良好手术切缘的同时,还能进行节省组织的切除。在肺癌筛查中,经常会发现一些较小、无法触及的肺部结节。这项技术允许切除亚厘米病灶,否则这些病灶在早期阶段将无法切除,从而可能提高生存率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Image-Guided VATS in the Hybrid Operation Room Facilitates Early Diagnosis and Concurrent Treatment of Subcentimeter Nonpalpable Lung Nodules.

Objective: As lung cancer screening increases, the detection of small, nonpalpable lung lesions is on the rise. The hybrid operation room (OR), which combines percutaneous or endobronchial fiducial placement with on-table computed tomography (CT) and fluoroscopic guidance, improves localization and facilitates the diagnosis and treatment of smaller, nonpalpable lung nodules with greater accuracy.

Methods: In 35 consecutive months, 55 veterans underwent 60 image-guided video-assisted thoracic surgery procedures for lesion resection. Of the cases, 36% were found during lung cancer screening. All patients received their care in the hybrid OR, where cone-beam CT scan technology was used to place an average of 1.6 fiducials percutaneously (n = 55) or via augmented navigational bronchoscopy (n = 5).

Results: A total of 66 lesions were resected. The median lesion size was 8 mm with an interquartile range of 6 to 14. The patients underwent nonanatomical resection with lymph node dissection using radiologic guidance. When indicated, an anatomical resection was subsequently performed. Of 47 total non-small cell lung cancer lesions, 83% were diagnosed at stage IA1 or IA2. The median surgical margin was 15 mm; the margin was usually 1.5 times as wide as the lesion.

Conclusions: The hybrid OR technology gives a 3-dimensional assessment of the small lung lesions, allowing for a tissue-saving resection while achieving good surgical margins. During lung cancer screening, smaller, nonpalpable lung nodules are frequently found. This technology allows resection of subcentimeter lesions, which would otherwise be unresectable at this early stage, possibly improving survival.

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来源期刊
CiteScore
2.00
自引率
6.70%
发文量
80
期刊介绍: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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