Application Of 3d Printed Template Navigation In Preoperative Localization Of Small Pulmonary Nodules

Objective: To investigate the application of 3D printed template navigation in preoperative localization of pulmonary nodules.Methods: The clinical data of 145 patients who underwent preoperative localization of small pulmonary nodules with anchor hook or percutaneous lung puncture under CT guidance in our hospital from September 2020 to December 2022 were analyzed retrospectively.Among the 145 patients,there were 70 males and 75 females.The age was 48.00(39.50,52.50)years old.Among them,70 patients with small pulmonary nodules with wire anchor hook were located with 3D printing guide plate before operation as the observation group,including 37 males and 33 females.The age was 44.00(38.00,53.00)years old.After the localization was completed,CT examination was performed to verify the localization effect,and single-hole thoracoscopic pulmonary wedge resection was performed.75 patients who underwent percutaneous lung puncture under the guidance of CT served as the control group,including 33 males and 42 females.The age was 48.00(43.00,52.00)years old.The peri-operative results of localization in the two groups were collected,and the baseline data,preparation time before localization,localization time of pulmonary nodules,localization accuracy,positioning decoupling rate and the degree of cooperation of patients were compared between the two groups.the total radiation dose received by the patient and the occurrence of related complications such as bleeding and pneumothorax during localization.Results: There was no significant difference in baseline data between the two groups.The location of the patients in both groups was completed successfully,and there was no emergency such as massive hemorrhage during the operation.Compared with the control group,the observation group was superior to the control group in preparation time [(5.17±1.43 min vs.8.11±2.43min),P<0.001],positioning time [(9.89±1.99 min vs.15.69±9.44min),P<0.001],patient cooperation(P<0.001),total radiation dose [7.00(7.00,14.00)m Sv vs.21.00(21.00,21.00)m Sv,P<0.001] and the cost of puncture [(2506.43±228.43)yuan vs.(4019.00±256.15)yuan,P<0.001]].In the two groups,the location accuracy [64(91.43%)vs.68(90.67%),P=0.873],the location decoupling rate [0 vs.2(2.67%),P=0.129],There was no significant difference in the error distance [(5.98±3.26 mm vs.5.49±3.00mm),P=0.343] and complications such as the incidence of pneumothorax during puncture [1(1.43%)vs.4(5.33%),P=0.198] and the incidence of bleeding during localization [1(1.43%)vs.2(2.67%),P=0.601].In addition,in the observation group,the relative inaccuracy of location in 6 cases was as follows: The diameter of pulmonary nodule was 6～8 mm.4 cases were located in the upper lobe,2 cases in the lower lobe,2 cases in solid nodule and 4 cases in ground glass nodule.while in the control group,the relative inaccurate localization in 7 cases was as follows: the diameter of pulmonary nodules was 6～9mm.3 cases were located in the upper lobe,1 case in the middle lobe,3 case in the lower lobe,and 7 cases were ground glass nodules.In addition,the average time for clinicians to design and make 3D printed guides for patients in the observation group was 131.11±7.24 min,and generally after5-10 min of design and production,clinicians were able to reach a degree of proficiency in making guides.Conclusions: It is safe and effective to use 3D printingnavigation template for preoperative positioning of pulmonary nodules.It can shorten the preparation time and positioning time before positioning and puncture,reduce the total dose of radiation and puncture cost on the premise of ensuring puncture accuracy and not increasing the positioning risk of pulmonary nodules,and has certain clinical value.However,the accuracy of this method in locating pulmonary nodules with diameter <10mm needs to be further improved.