末梢性肺腫瘤性病変に対する胸腔鏡下手術―塩酸リドカインゼリーを併用した色素法による術前マーキング―

CT-guided localization of pulmonary nodules with lidocaine-jelly and indocyanine-green for thracoscopic resection

色素法による術前CTガイド下マーキングに乳腺手術で応用される塩酸リドカインゼリーを添加する方法を施行した．末梢性肺結節性病変に対し胸腔鏡下生検術を予定した9症例，11病変を対象とした．インドシアニングリーン1ml，リピオドール0.2ml，キシロカインゼリー0.2mlを混和し色素液を調製し，CTガイド下に胸膜直下肺内に色素液を1ml注入した．9症例とも気胸，出血などの合併症は認めなかった．いずれの症例でもマーキングは胸膜下に限局した色素として明瞭に確認可能で，局所の同定に有用であった．本法は比較的安全であり，薬剤も安価で手技も容易である．市中病院における術前CTガイド下マーキングとして選択肢になりうると考えられた．

　As only peripheral subpleural lesions can be visualized at thoracoscopy, deep non-palpable pulmonary nodules have to be identified before performing wedge resection. Computed tomographic（CT）guided dye injections to localize these nodules before their thoracoscopic resection. However, this method has a week point in that the dye diffuses in the surface of the lung and it is difficult to point to the exact location under thoracoscopic view. We evaluate the efficiency of CT guided indocyanine-green（ICG）injections with Lidocaine-jelly for the localization of the dye. This method has been performed on the resection of mammary gland. The dye-mixture is made with 1 ml of ICG and 0.2 ml of lidocaine-jelly adding 0.2 ml of the ethylesteres of the fatty acids（lipiodol）for contrast medium. The dye-mixture is injected through a 23-gauge needle to stain the subpleural area overlying the nodule. Then CT was performed to examine the relationship of the target pulmonary nodule to the injected dye-mixture and to check for complications such as a pneumothorax and pulmonary hemorrhage. Eleven nodes in 9 patients were preoperatively localized under CT guidance and marked with the dye-mixture. The surgeons confirmed accurate localization of all nodes because lidocaine-jelly prevents the diffusion of the dye. We observed no complications such as pneumothorax and pulmonary hemorrhage. CT-guided localization of pulmonary nodules with lidocaine-jelly and indocyanine-green is a simple, effective, rapid and safe for thracoscopic resection.