CT-gestützte Drahtmarkierung vor videoassistierter thorakoskopischer OP von pulmonalen Rundherden – eine Auswertung von 184 Fällen

Zusammenfassung

Ziel: Minimalinvasive Techniken, wie die videoassistierte Thoraxchirurgie (VATS), sind heutzutage zur Resektion vor allem peripher gelegener Rundherde Methode der Wahl. Um eine schnelle und sichere intraoperative Lokalisation zu gewährleisten, haben sich diverse Markierungstechniken etabliert. Wir berichten über die Erfahrungen bei 184 Markierungen mittels eines speziellen Lungenmarkierungsdrahts, der CT-gestützt präoperativ an den Herd gebracht wird.

Material und Methoden: Bei 184 Patienten (97 m, 87w, mittleres Alter: 58,1 ± 13,7 Jahre) wurde unmittelbar vor der VATS eine CT-gesteuerte Markierung des Rundherds mithilfe eines Spiraldrahts vorgenommen. Evaluiert wurden anschließend die Erfolgsrate, die Sicherheit der Intervention, die Notwendigkeit eines Umstiegs zur Thorakotomie sowie die Histologie der Patienten.

Ergebnisse: Der Markierungsdraht konnte in 181 Fällen (98,4 %) erfolgreich platziert werden. Eine Markierung musste aufgrund eines nicht beherrschbaren Pneumothorax abgebrochen werden. Geringgradige, methodisch nicht vermeidbare Komplikationen wie Mantelpneumothoraces (53,3 %) oder perifokale Blutungen (30,4 %) bedurften keiner Therapie. Die makroskopisch vollständige Entfernung der markierten Herde gelang bei 98,4 % der Patienten. Aufgrund intraoperativer Komplikationen (Adhäsionen, Blutungen, Drahtdislokationen) war in 29 Fällen (15,9 %) die Konversion zur Thorakotomie erforderlich. Die Histologie ergab in 96 Fällen (52,5 %) einen benignen Befund, in 87 Fällen (47,5 %) einen malignen, wobei insgesamt lediglich 21 Herde (11,5 %) einem primären Lungenkarzinom entsprachen.

Schlussfolgerung: Die Kombination aus CT-gesteuerter Herdfixierung mittels Spiraldraht und die anschließende thorakoskopische Entfernung ist eine effiziente und sichere Methode zur Diagnostik von unklaren intrapulmonalen Rundherden, insbesondere für periphere, subpleural gelegene Herde.

Abstract

Purpose: Minimally invasive techniques like video-assisted thoracoscopic surgery (VATS) are currently the method of choice for the resection of small pulmonary nodules, when they are located in the periphery of the lungs. To guarantee quick and safe intraoperative identification of the nodule, preoperative marking is necessary and sensible. We report about our experiences in 184 markings with a special lung marking wire, which is placed in or around the pulmonary nodule using CT guidance.

Materials and Methods: In 184 patients (97 m, 87f, mean age: 58.1 ± 13.7 years) with pulmonary nodules, scheduled for resection with VATS, a special lung marking wire was placed preoperatively under CT guidance. We evaluated the technical success, safety, necessity of conversion to thoracotomy and histology in all patients.

Results: The marking wire could be positioned successfully in 181 cases (98.4 %). There was one major complication (uncontrollable pneumothorax). Minor adverse events like small pneumothorax (53.3 %) or a perifocal bleeding (30.4 %) did not necessitate treatment. Complete resection of the marked nodule was successful in 98.4 % of the patients. Conversion to thoracotomy was necessary in 29 patients (15.9 %) due to bleeding, adhesions, malignancy or wire dislocation. Histology revealed a benign nodule in 96 cases (54.4 %) and a malignant lesion in 78 cases (45.6 %), of which only 21 nodules (11.5 %) turned out to present a primary pulmonary carcinoma.

Conclusion: CT-guided marking of pulmonary nodules using a special marking wire followed by thoracoscopic resection is an efficient and safe method for diagnosing suspicious nodules in the periphery of the lung.

Key words

thorax - CT spiral - thoracoscopy - interventional procedures

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