Application Research Of Segmentectomy With Three-dimensional Reconstruction In The Treatment Of Early Lung Adenocarcinoma

BackgroundThe 2018 Global Cancer Report pointed out that the incidence and mortality of non-small cell lung cancer(NSCLC)are ranked first among malignant tumors.In recent years,the incidence of lung adenocarcinoma has gradually increased and has replaced squamous cell carcinoma as the most common pathological type of lung cancer.Surgery is the main treatment for NSCLC.In the past,thoracotomy was used for surgery,and lobectomy and systemic lymph node dissection were mostly used.With the development of medical technology,thoracoscopy has gradually been applied to the clinic,and the surgical treatment of NSCLC has gradually shifted from thoracotomy to thoracoscopic surgery.With the increasing popularity of lung cancer screening,NSCLC with diameters≤2 cm is increasingly being diagnosed clinically,and segmental or sub-segment resection of lung is more and more widely used in clinical practice.However,the anatomical structure of the lung segment is complex,the blood vessels and bronchi in the lung segment are variable,individualized differences are large,and the operation of segmental resection is difficult.Three-dimensional CT bronchial vascular reconstruction can visually display the lung tissue structure in 3D images.The surgeon can observe the patient’s anatomical structure stereoscopically before surgery to understand the position of the tumor and the shape and variation of the surrounding blood vessels and bronchial structures,and plan well.Surgical plan to prepare for the operation.The current study is to study the influence of conventional thoracoscopic anatomical segmentectomy and thoracoscopic anatomical segmentectomy under three-dimensional CT bronchial vascular reconstruction on early NSCLC surgery.ObjectiveTo study the effects of conventional thoracoscopic anatomical segmentectomy and thoracoscopic anatomical segmentectomy under three-dimensional CT bronchial vascular reconstruction on the intraoperative and postoperative effects of early NSCLC.In order to evaluate the feasibility and application advantages of three-dimensional CT bronchial vascular reconstruction in early NSCLC segmentectomy,and provide a theoretical basis for the promotion of three-dimensional CT bronchial vascular reconstruction.MethodsTo retrospectively analyze 115 cases of early NSCLC who underwent thoracoscopic anatomical segmentectomy from October 2018 to September 2020 in the Department of Cardiothoracic Surgery of the Fifth Affiliated Hospital of Zhengzhou University.The patients were divided into conventional thoracoscopic anatomical segmentectomy group and three-dimensional CT bronchial vascular reconstruction thoracoscopic anatomical segmentectomy group.Record and analyze the basic conditions of the two groups of patients before the operation,and compare the conditions of the two groups of patients during and after the operation.Data analysis and statistics use SPSS.23.0 software,using two independent sample t test,X~2 test,and repeated measures design analysis of variance statistical methods to compare the preoperative,intraoperative and postoperative conditions of the two groups of patients.ResultsBoth groups of patients successfully completed the operation.There were no Patients who transfer to thoracotomy and died during the perioperative period.All patients recovered and discharged from the hospital.There was no significant difference in age,gender,tumor diameter,preoperative C-reactive protein,smoking,drinking,hypertension,diabetes,coronary heart disease and other general conditions and comorbidities between the two groups(P>0.05).The operation time,intraoperative blood loss,postoperative pleural fluid drainage,and postoperative hospital stay in the thoracoscopic anatomical segmentectomy group under three-dimensional CT bronchial vascular reconstruction were less than those of conventional thoracoscopic anatomical segmentectomy,the difference is statistically significant(P<0.05).There were no statistically significant differences in the number of lymph node dissections,the number of predominant lung segment resections,and postoperative complications between the two groups(P>0.05).The postoperative pathology of both groups was lung adenocarcinoma.The CRP content of the two groups showed a decreasing trend at 1,3,and 5 days after surgery,but they were all higher than that before the operation;The CRP content 1,3,and 5 days after surgery in the group of thoracoscopic anatomical segmentectomy under three-dimensional reconstruction were lower than those of group of conventional thoracoscopic anatomical segmentectomy,and the difference was statistically significant(P<0.05)ConclusionsPreoperative three-dimensional CT bronchial vascular reconstruction can shorten the operation time,reduce intraoperative blood loss and postoperative pleural fluid drainage,shorten the patient’s hospital stay,and reduce the patient’s stress response.It is suitable for thoracoscopic anatomical segment resection in patients with early lung adenocarcinoma.