广东省肺癌研究所钟文昭团队：靶动脉流域分析法定位肺小结节的探索性研究

分享团队：

广东省肺癌研究所钟文昭团队

所刊杂志：

Translational Lung Cancer Research（点击查看杂志详情与影响因子）

文章标题：

靶动脉流域分析法定位肺小结节的探索性研究（Watershed analysis of the target pulmonary artery for real-time localization of non-palpable pulmonary nodules  ）

内容亮点：

本研究旨在探索靶动脉流域分析法定位肺小结节的安全性及可行性。

我们知道，部分位置特殊的肺结节是难以使用常规CT引导下经皮穿刺方法来实现精准定位的，比如靠近纵隔处、肺裂胸膜下、穿刺路径被肩胛骨、肋骨阻挡等。我们尝试使用三维重建及流域分析技术为这一问题提供解决方案。术前精准模拟出结节所在靶动脉的流域范围，评估与测量肺结节与流域范围的位置关系及距离，制定术中实时定位切除肺结节的手术策略。术中我们根据三维重建效果图，游离暴露对应的靶肺动脉，使用彩带活结阻断之，嘱外周静脉推注5ml吲哚菁绿，切换荧光，约10秒左右可见反染区域清晰呈现，遂以电刀标志后松开彩带，根据术前评估肺结节与流域范围的位置及距离，调整楔切角度与范围，保证切缘足够。

我们前瞻性入组26位患者，其中25位均使用流域分析技术成功定位并楔切。

平均肿瘤大小13.2±6.4 mm，平均肿瘤深度12.2±7.8 mm，平均手术时间142.6±52.8 min，术中平均出血量12.9±9.7 mL，平均引流管留置时间35.6±20.0 h，术后中位停留时间3天(范围2-6天)。

由此得出结论，靶动脉流域分析定位肺结节的方法是安全可行的。它可以为特殊位置肺结节的精准定位楔切带来福音。

Abstract

Background: Some pulmonary nodules are not suitable for computed tomography-guided percutaneous localization. This study aimed to investigate the feasibility and safety of real-time localization for these nonpalpable pulmonary nodules using watershed analysis of the target pulmonary artery during thoracoscopic wedge resection.

Methods: Watershed analysis is a novel technique that can be used to create a specific area on the lung surface for nodule localization. This analysis is performed by temporarily blocking the target pulmonary artery and using indocyanine green fluorescence during surgery. In our study, the surgery was simulated and evaluated preoperatively using a high-precision three-dimensional reconstruction model obtained by multidetector spiral computed tomography. The lung was observed using an infrared thoracoscopy system after an intravenous injection of indocyanine green (2.5 mg/mL), and the white-to-blue transitional zone was marked using electrocautery, after which a wedge resection was performed.

Results: A total of 25 out of 26 patients underwent successful wedge resection. The mean tumor size and depth based on computed tomography scans were 13.2±6.4 and 12.2±7.8 mm, respectively. The mean operation duration was 142.6±52.8 min. The mean bleeding volume during surgery was 12.9±9.7 mL. The mean drainage tube indwelling time was 35.6±20.0 h, and the median length of postoperative stay was 3 days (range, 2–6 days).

Conclusions:  Our experience showed that the watershed analysis of the target pulmonary artery for nodule localization was safe and feasible. It may become an effective and attractive alternative method for localizing non-palpable pulmonary nodules in selected patients undergoing thoracoscopic wedge resection.