*仅供医学专业人士参考
在复合手术室中影像引导下的VATS手术有助于亚厘米级隐匿性肺结节的早期诊断和同步治疗 AATS 2023
原文标题 Image Guided VATS in the Hybrid-Operation Room Facilitates Early Diagnosis and Concurrent Treatment of Sub-Centimeter Non-Palpable Lung Nodules
作者及单位 Michael Jaklitsch , Invited Discussant , Brigham and Women's Hospital
Carsten Schroeder , Abstract Presenter , Asheville VAMC
背景
随着肺癌筛查的增加，切除隐匿性的肺小结节需要改进定位技术。在复合手术室中，结合经皮或支气管内基底放置与CT和透视引导切除，允许治疗小的、隐匿性的结节更准确。 方法
在18个月的时间里，48名退伍军人接受了51次图像引导的VATS手术。平均病灶大小为11mm (4 ~ 29mm)，其中1/3(17/51)为肺癌筛查发现。所有患者均在混合手术室接受治疗，使用锥束ct扫描经皮(n=47)或增强导航支气管镜(n=4)平均放置1.6个基准点。平均使用2.2次ct扫描，一次用于放置，一次用于确认，或用于额外的标记放置。两个标记物之间的三角测量及其进入角度允许在切除时进行三维定位。通过术中透视引导切除，VATS手术得到加强。基准点辅助切除深度。 结果
平均年龄70.9岁。大多数是白人和男性，有多种合并症。平均吸烟包年为45年，其中19/48人目前吸烟(40%)。共切除病灶56个。5例同时性肺癌。24个病灶测量值≤9mm。13个病变测量≤6mm。在放射学指导下进行非解剖性切除，并进行淋巴结清扫。当有指示时，随后在相同的情况下进行解剖切除。8例为转移性检查。7个病变为良性。在38个NSCLC病变中，79%(30/38)诊断为IA1或IA2期。一例死亡是由于转移性疾病楔形切除后ILD恶化。NSTEMI 1例，房颤1例，长时间漏气5例。平均透视时间为2.8 min，每例DAP (mGycm2)为20,060。这种低辐射剂量是通过使用专门的肺锥束ct扫描方案实现的，剂量减少了75%。 结论
复合手术室技术支持借助放射学上可见的基准标记物对隐匿性病变的早期诊断和治疗。此外，该技术提供病变的3D评估，允许组织保存切除，同时获得良好的肿瘤手术边缘。这项技术可以切除亚厘米的病变，否则不会在这么早的时候切除。
作者简介
Michael Jaklitsch
[size=75%]Invited Discussant
Dr. Mike Jaklitsch holds the Jack Mitchell Distinguished Chair in Thoracic Surgery at Brigham and Womens Hospital in Boston. He is Professor of Surgery at Harvard Medical School.
Carsten Schroeder
[size=87.5%]Abstract Presenter
[size=87.5%]A. Personal Statement
I have a background in surgical science working with molecular biology markers and animal models of different sizes. Therefore, targeting a special cell population in tissue and blood is a common problem for me and I have used several techniques to identify different cell types in various states of activation and development.
Clinically, I bring expertise in current lung cancer treatment to the project in conjunction with participating in the multidisciplinary approach to patient care in our institution. I am working directly with lung cancer patients and perform most of the lung cancer surgery at CGVAMC. I will refer patients for future clinical trials; assist with patient enrollment at the multidisciplinary clinic. I will be involved in study design, data interpretation and scientific paper writing. B. Positions, Scientific Appointments, and Honors
Positions and Employment
2019-present, Chief Thoracic Surgery, CGVAMC Asheville, NC 2014-2019, Associate Professor of Surgery, College of Medicine, Georgia Regents University 2009-2013, Assistant Professor of Surgery, College of Medicine, Case Western University, Cleveland
Other Experience and Professional Memberships
The Society for Thoracic Surgeons The Transplantation Society European Association for Cardiac and Thoracic Surgery
Honors
2001-2003 DFG-Stipend (German Research Foundation) Role of Complement C5a in pulmonary discordant xenograft rejection
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（翻译及审校：刘浩）
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