亚肺叶切除时代肺标记的作用
Role of Lung Marking in the Age of Sublobar Resection.
作者
作者单位
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
- Division of Pulmonary Medicine, Lennox Hill Hospital, New York, New York, USA.
- Division of Pulmonary, Critical Care and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
- Division of Pulmonary Medicine, Advocate Aurora Health, Kenosha, Wisconsin, USA.
摘要
中文
鉴于最近的临床试验，我们正在见证早期肺癌保留肺实质的亚肺叶切除术的范式转变。通过胸腔镜进行亚肺叶切除时，有时定位病灶可能具有挑战性。胸腔镜不能提供与开放胸廓切开术相同的暴露和触觉反馈；因此，胸外科医生可能难以检测亚实性、小而深的病灶。这个问题可以通过术前标记病灶来避免。已经报道了各种CT引导的经胸和支气管镜技术。经胸技术包括向病灶注射染料、放置基准标记物和钩线。尽管这些手术被广泛进行，但已经报告了并发症，如气胸、空气栓塞、染料扩散和外渗，以及钩线脱位。传统支气管镜可以与实时三维成像结合用于经支气管标记肺部病灶。然而，鉴于传统支气管镜的局限性，导航到外周病灶可能困难。机器人支气管镜，无论是否使用实时三维成像，都是标记肺部病灶的安全且准确的方式。机器人支气管镜可用于向病灶注射染料，可能在与切除术相同的环境中进行。机器人支气管镜也可用于经支气管部署染料浸泡的线圈。机器人支气管镜可能尚未广泛使用，并且可能有学习曲线。最终，肺标记方式的选择取决于可用资源、机构专业知识和每种方式的特定优缺点。
English
In light of recent clinical trials, we are witnessing a paradigm shift towards lung parenchyma-preserving, sublobar resection for early-stage lung cancers. When performing sublobar resection via thoracoscopy, sometimes locating the lesion can be challenging. Thoracoscopy does not provide the same exposure and tactile feedback as open thoracotomy; as a result, detecting subsolid, small, and deep lesions can be difficult for the thoracic surgeon. This problem can be obviated by preprocedural marking of lesions. Various CT-guided transthoracic and bronchoscopic techniques have been reported. Transthoracic techniques include injecting dye into the lesions and placing fiducials and hook wires. Although these procedures are widely performed, complications, such as pneumothorax, air embolism, dye dissipation and extravasation, and hook-wire dislodgement have been reported. Conventional bronchoscopy can be used in conjunction with real-time 3-dimensional imaging for transbronchial marking of pulmonary lesions. However, given the limitations of conventional bronchoscopy, navigating to peripheral lesions can be tough. Robotic bronchoscopy, with or without real-time 3-dimensional imaging, is a safe and accurate modality for marking pulmonary lesions. Robotic bronchoscopy can be used to perform dye injection into the lesion, potentially in the same setting as the resection. Robotic bronchoscopy can also be used to bronchoscopically deploy dye-soaked coils. Robotic bronchoscopy may not be widely available and may have a learning curve. Ultimately, the choice of lung marking modality depends on available resources, institutional expertise, and the specific advantages and disadvantages of each modality.
分类与指标
- 研究类型
- 综述Meta
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 7.2
- 新锐分区
- 2区