Value Of Three-dimensional Reconstruction Combined With Hook Wire Localization In The Treatment Of Pulmonary Ground Glass Nodules

Objective:The purpose of this study was to investigate the feasibility,safety and value of three-dimensional reconstruction combined with hook-wire in the localization of pulmonary ground glass nodules for thoracoscopic segmentectomy.Materials and methods:According to the inclusion and exclusion criteria,141 patients with pulmonary ground glass nodules who underwent thoracoscopic hand resection and preoperative three-dimensional reconstruction in the thoracic surgery of The First Bethuen Hospital of Jilin University from September 2019 to December2021 were retrospectively collected.They were divided into localization group and control group according to whether they completed the puncture and localization of hook-wire lung ground glass nodules under the guidance of CT before operation,at the same time,the positioning group is divided into the positioning related complication group and the non-positioning related complication group according to whether the patients have positioning related complications（such as pneumothorax,bleeding and positioning needle falling out of lung tissue after positioning）.The basic information of all patients is collected,and the relevant clinical data such as operation time,intraoperative bleeding,postoperative catheterization days and postoperative complications are collected.The quantitative data conforming to the normal were expressed by means ± standard deviation,the non-normal data were expressed by M（IQR）,and the counting data were expressed by rate or component ratio.The comparison between groups was expressed by t-test,Z-test,chi square test or Fisher exact probability method,P < 0.05.The difference was considered to be statistically significant.Results:Six（14.63%）of the 41 patients in the localization group had localization related complications.The average operation time was（2.14 ± 0.62）h,the average intraoperative bleeding was（34.51 ± 20.06）ml,the average postoperative catheterization time was（3.40 ± 0.90）d,and the drainage volume on the first day after operation was（168.44 ± 85.12）ml.In the non-positioning group,the average operation time was（2.63 ± 0.92）h,the average intraoperative bleeding was（70.55 ± 63.12）ml,the average postoperative catheterization time was（4.30 ± 1.30）d,and the drainage volume on the first day after operation was（246.8 ± 186.04）ml.The results showed that the operation time,intraoperative bleeding,postoperative catheterization time and drainage volume on the first day after operation in the localization group were significantly lower than those in the non-localization group（P < 0.05）;There was no significant difference between the two groups in chest volume on the second day after operation,chest volume on the third day after operation and postoperative pathology（P > 0.05）.In the localization group,there was no significant difference in the basic data between the localization related complications group and the non localization related complications group.The operation time and intraoperative bleeding volume in the localization related complications group were significantly higher than those in the non-localization related complications group（P < 0.05）;There was no significant difference in the number of days of catheterization,the distance between the nodule and the visceral pleura,and the length of needle insertion between the two groups（P > 0.05）.Multivariate analysis of risk factors for patients with positioning related complications showed that the falling off of positioning needle was an important risk factor for positioning related complications（or = 5.979,95% CI = 3.289-8.663,P = 0.014）,and BMI was a protective factor for positioning related complications（or = 0.628,95% CI =0.411-0.959,P = 0.031）.The working characteristic curve of subjects was analyzed for patients with positioning related complications,BMI has certain clinical diagnostic value for the occurrence of localization complications.The results show that when BMI is less than 26.37,it indicates that patients have localization complications（95% CI: 0.000-0.422,P = 0.020）.Conclusion:（1）Three-dimensional reconstruction combined with hook-wire localization under CT guidance is helpful to carry out accurate thoracoscopic segmentectomy and reduce the operation time and intraoperative bleeding.At the same time,it can effectively shorten the postoperative tube time and hospital stay.（2）The hook-wire localization under CT guidance is safe and reliable.It can accurately locate the focus during operation and reduce the time to find the focus of isolated specimens.（3）BMI has certain clinical diagnostic value in locating whether patients have complications.