Objective: To explore the clinical value of four dimensional computed tomography (4 D CT) guided combined with deep inhalation and breath hold (DIBH) technique in the preoperative localization of solitary pulmonary nodules. Methods: The data of a total of 106 patients with solitary pulmonary nodules from March 2018 to May 2021 in the Ningbo First Hospital were collected retrospectively. Among them, there were 26 males and 80 females aged from 21 to 83 (47.4±14.2) years. According to different localization methods, 53 cases were divided into the control group, as the pulmonary nodules were located by CT guided injection of indocyanine green under calm breathing and 53 cases were divided into in the experimental group, as those patients were treated with indocyanine green injection under the guidance of 4 D CT combined with DIBH technology to locate pulmonary nodules. The three-dimensional distance deviation between pulmonary nodules and indocyanine green injection points was compared between the two groups to obtain the accuracy of pulmonary nodule localization. The preoperative positioning time of the two groups was compared by timing. Results: Among the 106 patients, there were 46 pure ground glass nodules, 32 sub solid nodules and 28 solid nodules, all of which were successfully localized before operation, with a success rate of 100%. The size of pulmonary nodules in the control group was (9.1±2.3) mm and the three-dimensional deviation[M(Q1, Q3)]between indocyanine green injection site and pulmonary nodules was X axis [7.0 (3.7, 12.6)] mm, Y axis [6.6 (2.9, 11.2)] mm, Z axis [3.0 (2.0, 6.0)]mm, respectively, and the preoperative positioning time was (11.4±3.8) min. The size of pulmonary nodules in the experimental group was (8.9±2.1) mm, and the deviations in 3 D direction were X axis [4.8 (3.0, 7.9)]mm, Y axis [3.8 (1.3, 7.5)]mm, Z axis [4.0 (2.0, 6.0)] mm, respectively. The preoperative positioning time was (9.3±3.0) min. There were statistically significant differences in preoperative positioning time and deviation of X and Y axis between the experimental group and the control group (P<0.05), but no statistically significant differences was found in deviation of Z axis (P>0.05). Conclusion: 4 D CT guided DIBH technology could improve the accuracy of preoperative localization of pulmonary nodules and save operation time, which is worthy of popularization.
目的： 探讨四维CT（4 D CT）引导下联合深吸气屏气（DIBH）技术在孤立性肺结节术前定位中的应用价值。 方法： 回顾性收集宁波市第一医院2018年3月至2021年5月106例孤立性肺结节患者资料，其中男26例，女80例，年龄21~83（47.4±14.2）岁。按照定位方式不同分成对照组53例，采用平静呼吸下CT引导注射吲哚菁绿定位肺结节；试验组53例，采用4 D CT引导联合DIBH技术注射吲哚菁绿定位肺结节。比较两组患者肺结节与吲哚菁绿注射点的三维方向距离偏差，得到肺结节定位的精确度；采用计时方式比较两组患者的术前定位时间差异。 结果： 106例患者中，有46例纯磨玻璃结节，32例亚实性结节，28例实性结节；术前均成功定位，成功率100%。对照组肺结节大小为（9.1±2.3）mm；吲哚菁绿注射点与肺结节的三维方向偏差［M（Q1，Q3）］为X轴［7.0（3.7，12.6）mm］、Y轴［6.6（2.9，11.2）mm］、Z轴［3.0（2.0，6.0）mm］；术前定位手术时间为（11.4±3.8）min。试验组肺结节大小为（8.9±2.1）mm；三维方向偏差为X轴［4.8（3.0，7.9）］mm、Y轴［3.8（1.3，7.5）］mm、Z轴［4.0（2.0，6.0）］mm；术前定位手术时间为（9.3±3.0）min。试验组和对照组术前定位时间以及三维方向中X、Y轴偏差差异均有统计学意义（均P<0.05），Z轴偏差差异无统计学意义（均P>0.05）。 结论： 4 D CT引导下联合DIBH技术能够提高肺结节术前定位的精确度，节省时间，具有一定的推广价值。.