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目的探讨Hybrid手术室中施行胸腔镜手术对肺部周围型微小病灶进行快速精准切除的价值。方法 2011年3月～2012年2月,在我院新建的Hybrid手术室中,对16例19处肺部周围型微小病灶施行胸腔镜手术切除。患者术前当日在胸部CT引导下经皮穿刺,在病灶处放置血管栓塞用金属弹簧圈定位。病灶定位后将患者接入Hybrid手术室,手术在间断多角度下进行,根据电视屏幕上弹簧圈标记物与胸腔镜操作器械的相对位置和胸腔镜下胸腔内术野的实时影像,确定手术切除部位及范围,在距病灶约3 cm距离处应用强生60 mm直线型切割缝合器,对病变肺叶实施楔形切除,切除的病变组织送快速病理,根据病理报告进行下一步处理。结果所有目标病灶均顺利切除,手术时间15～42 min。良性病变9枚,楔形切除;肺癌10枚,其中1例为双上肺早期鳞癌,行双侧上肺叶楔形切除,其余9例行胸腔镜下肺叶切除及纵隔淋巴结清扫。无中转开胸,无严重术后并发症,无围术期死亡。14例随访1～12个月,平均6.4月,9例恶性病变未见转移和复发。结论术前胸部CT引导下经皮穿刺金属弹簧圈对肺部周围型微小病灶精确定位,通过在Hybrid手术室的实时透视下胸腔镜技术,可以对目标病灶施行精准切除。
Objective To investigate the value of rapid and accurate excision of small lesions around the lung by thoracoscope surgery in Hybrid operating room. Methods From March 2011 to February 2012, thoracoscopic surgery was performed in 16 cases of 19 small pulmonary peripheral lesions in a newly constructed hybrid operating room in our hospital. The patient underwent percutaneous puncture under the guidance of chest CT on the day before surgery. Blood vessel embolization was placed with a metal coil in the lesion. After the lesion is located, the patient is connected to the Hybrid operating room, and the operation is performed under intermittent multi-angle. According to the real-time images of the coil markers and thoracoscope operating instruments on the TV screen and the thoracoscopic intrathoracic operative field, the surgical resection is determined Site and range, at a distance of about 3 cm from the lesion, Johnson & Johnson 60 mm linear stapler was used to perform wedge resection on diseased lobe. The diseased lesion was removed for rapid pathology and the next step was performed according to the pathology report. Results All the targeted lesions were successfully resected and the operation time was 15-42 min. 9 benign lesions, wedge resection; 10 lung cancer, including 1 case of double upper lung squamous cell carcinoma, bilateral lobes wedge resection, and the remaining 9 cases underwent thoracoscopic lobectomy and mediastinal lymph node dissection. No transfer thoracotomy, no serious postoperative complications, no perioperative death. Fourteen patients were followed up for 1 to 12 months, with an average of 6.4 months. No metastases and recurrences were found in the 9 malignant lesions. Conclusions Percutaneous puncture metal coil under the guidance of chest CT can accurately locate the tiny lesions around the lung. Through real-time fluoroscopic thoracoscopic surgery in Hybrid operating room, the target lesion can be accurately excised.