Click on the Shaw Hospital star
Some time ago, a big uncle came to the multidisciplinary collaborative diagnosis and treatment clinic of lung nodules in Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine.
Uncle Li (pseudonym) was found during a physical examination of a lung ground glass density nodule. After analysis and discussion by a number of experts in the Department of Respiratory and Critical Care Medicine, Thoracic Surgery, Radiology and Oncology, it is believed that the malignancy of this nodule on the lungs of Uncle Dabo is more likely, and it is recommended that Uncle Dabo be admitted to the hospital for visual thoracoscopic pulmonary nodectomy.
After admission, Uncle Da was informed to have a preoperative lung nodule localization. Uncle Li was a little puzzled: "Doctor, don't you see the location of my lung nodule very clearly on CT?" Why positioning? ”
Chen Zhoumiao, deputy chief physician of the Department of Thoracic Surgery, patiently explained: "Our lungs are like a balloon, and the lung nodules are like a spot on the surface of the balloon or inside the balloon. Normally, when the balloon bulges up, we can know the approximate location of the lung nodule based on CT. But when we operate, this side of the lung is not ventilated, the lung is collapsed, that is to say, the balloon is deflated, then the location of the lung nodule will change in this case, especially the small, ground glass nodule is difficult to find. This requires us to mark these lung nodules near them before surgery, so that the pulmonary nodules can be localized through the markers during surgery and then precisely removed. ”
After listening to the doctor's explanation, Uncle Li suddenly realized.
Subsequently, Jiang Hanliang, deputy chief physician of the Department of Respiratory and Critical Care Medicine, performed lung nodule localization for Li Dabo, and successfully performed visual thoracoscopic pulmonary nodectomy, and Li Dabo recovered well after the operation.
It is not easy to remove small nodules precisely
How do I locate it?
Dyna CT-guided percutaneous memory spring coil lung nodule localization in the Respiratory and Critical Care Department of Run Run Shaw Hospital has been successfully performed for preoperative localization of many patients with lung nodules who require surgical thoracoscopic resection.
Preoperative lung nodule localization process under C-arm CT
Chen Enguo, chief physician of the Department of Respiratory and Critical Care Medicine, introduced: "We use the most advanced positioning machine, that is, C-arm CT; C-arm CT uses a cone-shaped beam X-ray to scan the patient at 360 degrees, the projection data is two-dimensional, and the three-dimensional image is obtained after reconstruction, compared with the one-dimensional projection of ordinary CT, two-dimensional reconstruction has advantages, lower radiation, shorter time: In terms of auxiliary positioning, the patient's puncture point can be directly located after three-dimensional reconstruction, avoiding the need for repeated injections and multiple scans to determine the location under the guidance of ordinary CT At the same time, the C-arm CT is relatively low in radioactivity compared to ordinary CT, which can significantly reduce the radiation exposure of patients; in addition, the memory spring coil we use for positioning is also a newly developed positioning material, which is made of new nickel-titanium alloy material, which can form a unique dumbbell-shaped structure after positioning, and facilitate the rapid positioning of nodules in the operation of the operator in the tail structure outside the lung. ”
The position of the spring ring is visible during surgery
Specimens after resection may show pulmonary nodules and spring rings
The Department of Respiratory and Critical Care Medicine of Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine is affiliated with the National Respiratory Regional Medical Center, which is the first batch of PCCM and respiratory endoscopic physician training bases in the country, and is also the chairman unit of the Respiratory Branch of Zhejiang Medical Association, the chairman unit of Zhejiang Pulmonary Vascular Alliance, the chairman unit of Zhejiang Respiratory Endoscopy Alliance, and one of the earliest units in the province to carry out intraoral interventional diagnosis and treatment, and has now comprehensively carried out various interventional diagnosis and treatment technologies, of which many technologies are the first units in the province. It is the only unit in the province with independent DSA equipment in respiratory specialties, and is also the first batch of C-arm CT-guided lung nodule positioning, electromagnetic and virtual navigation under transbronchoscopic peripheral nodule biopsy, the first batch of units to introduce endoscopic minimally invasive diagnostic technologies such as confocal imaging, and the level of endoscopic comprehensive diagnosis and treatment is leading in China, and it is the leader of respiratory intervention in the province.
Source: Run Run Shaw Hospital
Author: Yafang Wang, Department of Respiratory and Critical Care Medicine
Original works, reprinted please indicate the source and source
share
Click Favorites
Thumbs up