Clinical experience of VATS diagnosis and treatment of pulmonary nodules less than 20 mm in size
10.3760/cma.j.issn.1001-4497.2012.07.004
- VernacularTitle:109枚直径小于20mm的肺内结节的胸腔镜诊疗
- Author:
Daoming LIU
;
Shunkai ZHOU
;
Meimian HUA
;
Xuegang FENG
;
Duohuang LIAN
;
Chaoyang CHEN
;
Long CHEN
;
Shengsheng YANG
- Publication Type:Journal Article
- Keywords:
Video-assisted thoracoscopic surgery;
Solitary pulmonary nodule;
Pulmonary wedge resection Lobectomy
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2012;28(7):394-397
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the technique of finger palpation in thoracoscopic localization in patients with pulmonary nodules,and to summarize its technical details,especially with exploit of chest computed tomography (CT) facilitating it.Methods 95 patients with total amount of 109 pulmonary nodes 20 mm or smaller in size shown with lung window of CT,were reviewed.They were located subpleurally,with a median depth of 8.2 mm and a median size of 10.0 mm.The value of their depth over their size (D/d value) could be used as the extent of localizing difficulty.Each node had its own radiographic fealures for being localized,which was built preoperatively.Under thoracoscopic vision,nodules were finger-palpated by index finger via the 4th or 5th intercostal space on anterior axillary line,followed by wedgectomy or lobectomy for instant histopathological diagnosis to further decide the final surgical type.The distance between the nodule and the origin of segmental bronchus (L value) were also calculated out,as it might be relevant to the way the nodule could be biopsied.Results All nodules were successfully localized and resected for biopsy goal,105 by wedgectomy,4 by lobectomy.After intraoperative diagnosis was made by the pathologist,VATS lobectomy and lymph node dissection were further performed in 55 patients.L value of 4 cases being biopsied by lobectomy ranged from 18.3 to 30.3 mm,averaging 26.1 mm.Conclusion Finger palpation is viable in any cases of pulmonary nodules.Detailed reference of CT digital information,and enough detachment of mediastinal pleura,can greatly facilitate thoracoscopic localization by finger palpation.Lobectomy or segementectomy is preferable when L value is less than 30 mm.
