探讨自体血在肺小结节术前CT引导下定位的应用价值。

收集中国科学技术大学附属第一医院胸外科2018年9月至2019年6月间肺内小结节采用自体血CT引导下经皮穿刺辅助定位的患者共30例，定位结节36枚，术前24 h内完成定位后进行手术，统计分析定位效果、并发症、病理资料及手术方案等相关资料。

CT显示结节直径4～17 mm，平均（9.22±3.51）mm。病灶与胸膜垂直距离0～20 mm，平均（6.97±5.73）mm。穿刺胸膜进针点与病灶间距离1～36 mm，平均（10.97±7.70）mm。定位成功率93.3%。从确定穿刺路径至定位完成平均操作时间为（13.38±6.09）min。穿刺后出现中等量气胸1例、少量气胸1例、少量血气胸1例、少量血胸1例，肺内血肿形成2例，均未予以特殊处理，总体并发症发生率20%。36枚结节中手术方式采用楔形切除26例（72.2%），肺段切除5例（13.9%），肺叶切除5例（13.9%）。病理结果诊断为恶性结节28例，良性结节8例。

自体血用于外周胸膜下肺小结节术前CT引导定位安全有效，副作用小，是一种理想的定位材料。

To evaluate the clinical value of CT-guided percutaneous injection of autologous blood for preoperative localization in patients with small pulmonary nodules.

Total of 30 patients with 36 cases of pulmonary nodules were marked by percutaneous autologous blood injection under CT guidance preoperatively in the thoracic surgery department of the first affiliated hospital of USTC between September 2018 and June 2019. The localization effect, complication, pathological results and operation relates data were statistically analyzed.

CT showed that the diameter of the nodules was 4-17 mm, with an average of (9.22 mm±3.51 mm). The vertical distance between the lesion and pleura was 0-20 mm, with an average of (6.97 mm±5.73 mm). The distance between the puncture pleural entry point and the lesion was 1-36 mm, with an average of (10.97 mm±7.70 mm). The success rate of positioning is 93.3%.The average operation time from the determination of puncture path to the completion of positioning was (13.38 min±6.09 min). After puncture, 1 patient presented with moderate pneumothorax, 1 patient presented with small pneumothorax, 1 patient presented with small hemopneumothorax, 1 patient presented with small hemothorax, 2 patients presented with intrapulmonary hematoma formation, all of which were not specially treated, and the overall complication rate was 20%. Wedge resection was performed in 26 patients (72.2%), segmentectomy was peformed in 5 patients (13.9%), and lobectomy was peformed in 5 patients (13.9%).Pathological results showed 28 cases of malignant nodules and 8 cases of benign nodules.

Autologous blood is an ideal positioning material for preoperative CT guided localization of peripheral subpleural pulmonary nodules, which is safe and effective with few side effects.