| Objective: To explore and compare the clinical value of different preoperative CT guided puncture localization methods for the removal of pulmonary nodules by Video-assisted Thoracoscopy Surgery(VATS).Methods: Totally 125 patients with pulmonary nodules who underwent CT guided percutaneous lung puncture assisted VATS surgery from January 2020 to July 2022 in the First Affiliated Hospital of Shihezi University were retrospectively collected.Among them,a total of 60 nodules in 59 patients used MB(Methylene blue)as localization material,known as the MB blue group,51 nodules in 42 patients used metal spring coils as localization material,known as the spring coil group,and 24 patients used MB staining for supplementary localization of 32 nodules during spring coil implantation,known as the combination group.Compare whether there are differences among the three groups in the success rate of localization,the success rate of wedge resection,the length of localization operation,the scope of surgical resection,the number of postoperative hospital stay and the incidence of complications.All patients were divided into a bleeding group(n=21)and a non bleeding group(n=104)based on whether there was postoperative intrapulmonary bleeding after localization surgery.Univariate and multivariate analysis was conducted to determine the influencing factors of localization complications.Results: The success rates of localization and wedge resection in the MB group were 91.7% and 95.0%respectively,the success rates of localization and wedge resection in the spring resection group were 96.1%and 100% respectively,and the success rates of localization and wedge resection in the combined group were 93.8% and 93.8% respectively.There was no statistical difference between the three groups(P>0.05).The duration of positioning operation in the spring coil group(11.49 ± 2.50 min)was lower than that in the MB group(13.82 ± 3.47 min)and the combination group(13.63 ± 2.91 min),and the difference was statistically significant(P<0.05).The resection range of VATS in the MB group was higher than that in the other two groups,and the difference was statistically significant(P<0.05).The postoperative hospital stay of patients in the MB group(12.90 ± 5.18 days)was more than that in the spring coil group(7.05 ± 1.86days)and the combined group(8.96 ± 3.43 days),with a statistically significant difference(P<0.05).The incidence of pneumothorax in the three groups was 18.6%(11 cases)in the MB group,21.4%(9 cases)in the spring coil group,and 25.0%(6 cases)in the combined group.There was no significant difference in the incidence of pneumothorax among the three groups(P>0.05).The incidence of postoperative intrapulmonary hemorrhage in the three groups was 28.8%(17 cases)in the MB group,7.1%(3 cases)in the spring coil group,and 4.2%(1 case)in the combined group.The incidence of intrapulmonary hemorrhage in the MB group was higher than that in the other two groups,and the difference was statistically significant(P<0.05).Among the influencing factors of postoperative intrapulmonary bleeding,having a history of lung disease [OR=5.591,95CI(1.836-17.028)] is an independent risk factor for intrapulmonary bleeding in patients,with a statistically significant difference(P<0.05).However,the use of spring coils during localization [OR=0.131,95CI(0.038-0.448)] is a protective factor for postoperative intrapulmonary bleeding in patients,with a statistically significant difference(P<0.05).Conclusion: Preoperative CT guided MB localization,spring coil localization and combined localization can effectively assist VATS pulmonary nodule resection.In addition,compared with pure MB localization,simple spring coil localization and spring coil combined with MB localization have smaller resection scope,lower incidence of postoperative intrapulmonary hemorrhage,shorter hospital stay and higher safety. |
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