Analysis Of The Clinical Effect Of Anatomic Segmentectomy In The Treatment Of Stage IA Non-small Cell Lung Cancer Under The Guidance Of Three-dimensional Reconstruction

Objective:To explore the clinical effect of anatomic segmentectomy in the treatment of stage IA non-small cell lung cancer under the guidance of three-dimensional reconstruction.Methods:Retrospective analysis of the medical records of 160 patients who underwent lung cancer surgery in the Department of Thoracic Surgery,the First Affiliated Hospital of Jilin University from April 2018 to February 2020 were conducted.According to the surgical methods,they were divided into: 42 cases of thoracoscopic segmentectomy under three-dimensional guidance(group A)and 56 cases of thoracoscopic segmentectomy(group B);62 cases of thoracoscopic lobectomy(group C).All enrolled patients strictly followed the inclusion criteria,excluded contraindications after detailed preoperative examination,and were actively prepared for preoperative surgery and then underwent surgical treatment.The operation time,intraoperative blood loss,postoperative hospital stay time,postoperative catheterization time,drainage volume on the first day after the operation,drainage volume on the second day after the operation,drainage volume on the third day after the operation,total drainage volume after the operation and postoperative complications were compared.SPSS22.0 statistical software was used to conduct statistical analysis on the three groups of data,and F test was used to compare the operation time,intraoperative blood loss,postoperative hospital stay time,postoperative catheterization time,drainage volume on the first day after the operation,drainage volume on the second day after the operation,drainage volume on the third day after the operation,total drainage volume after the operation;chi-square test was used to compare postoperative complications,the difference was statistically significant when P<0.05.Results:All patients in the three groups successfully completed the operation,and no perioperative death occurred.There was no significant difference between the data of the patients,and the data had good comparability.Group A: operation time(116.43±27.81)min,intraoperative blood loss(89.52±28.79)ml,postoperative hospitalization days(5.26±1.33)d,postoperative catheterization time(3.69±0.98)d,postoperative drainage volume on the first day(148.41± 83.68)ml,postoperative drainage volume on the second day(130.00±46.75)ml,postoperative drainage volume on the third day(107.38±68.54)ml,postoperative total drainage volume(500.02±195.23)ml.Postoperative pathology: infiltrating adenocarcinoma: 2 cases;Microinvasive adenocarcinoma: 30 cases;In situ adenocarcinoma: 10 cases;Postoperative complications:1 case of pulmonary infection,1 case of atelectasis,1 case of arrhythmia;2 cases of lung leakage;1 case of hemoptysis;Group B: operation time(130.30± 29.96)min,intraoperative blood loss(113.39±37.67)ml,postoperative hospitalization days(6.09±1.28)d,postoperative catheterization time(4.39±1.26)d,postoperative drainage volume on the first day(196.48±99.78)ml,postoperative drainage volume on the second day(174.02±58.89)ml,postoperative drainage volume on the third day(137.79±61.46)ml,postoperative total drainage volume(620.57±202.26)ml.Postoperative pathology: infiltrating adenocarcinoma: 3 cases;Microinvasive adenocarcinoma: 47 cases;In situ adenocarcinoma: 6 cases;Postoperative complications: 9 cases of pulmonary infection,1 case of atelectasis,1 case of arrhythmia,3 cases of lung leakage,10 cases of hemoptysis;Group C: operation time(150.68±37.38)min,intraoperative blood loss(128.87±52.14)ml,postoperative hospitalization days(6.71±1.59)d,postoperative catheterization time(5.21±1.48)d,postoperative drainage volume on the first day(220.16±108.04)ml,postoperative drainage volume on the second day(194.20±67.52)ml,postoperative drainage volume on the third day(155.65±63.34)ml,postoperative total drainage volume(783.24±202.97)ml.Postoperative pathology: Squamous cell carcinomas: 4 cases;infiltrating adenocarcinoma: 49 cases;Microinvasive adenocarcinoma: 9 cases;In situ adenocarcinoma: 10 cases;Postoperative complications: 4 cases of pulmonary infection,1 case of atelectasis,2 case of arrhythmia,3 cases of lung leakage,5 cases of hemoptysis.Statistical comparison: the operation time,intraoperative blood loss,postoperative hospital stay and postoperative catheterization time of group A and group B were all decreased compared with group C(P<0.05),while the operation time,intraoperative blood loss,postoperative hospital stay and postoperative catheterization time of group A were lower than that of group B,with statistically significant differences(P<0.05).The drainage volume on the first day after the operation,the second day after the operation,the third day after the operation,and the total drainage volume after the operation were all decreased in group A compared with group B and C(P<0.05).The total postoperative drainage volume of group B was lower than that of group C(P<0.05),while the drainage volume of group B on the first day after operation,the second day after operation and the third day after operation had no statistical significance compared with that of group C(P>0.05).Postoperative complications: pulmonary infection and hemoptysis in group A were less than those in group B with statistically significant differences(P<0.05).There was no significant difference in other complications such as atelectasis,arrhythmia and lung leakage among the three groups(P>0.05).Conclusion:(1)In the treatment of stage IA non-small cell lung cancer,preoperative three-dimensional reconstruction can understand the vascular variation of the patient before surgery,which is beneficial to the patient’s lesion location,preoperative evaluation and the development of a surgical plan.(2)Three-dimensional reconstruction is applied during the operation,which can play a precise navigation role,ensure the safety of the operation,shorten the operation time,effectively reduce the intraoperative bleeding,postoperative complications such as pulmonary infection,hemoptysis.(3)Preoperative three-dimensional reconstruction can accurately locate the nodule position during surgery,and ensure the most appropriate surgical resection margin to ensure the most appropriate surgical resection range,which can effectively reduce the first day of postoperative drainage,the second day of postoperative drainage,and The drainage volume on the third day and the total drainage volume after surgery further reduce the time for postoperative catheterization and the length of hospital stay after surgery,which is more conducive to the early recovery of patients with stage IA lung cancer.