Study On The Effectiveness,postoperative Complications And Risk Factors Of CT-Guided Coil Positioning Technique In Thoracoscopic Resection Of Pulmonary Nodules

Objective To explore the effectiveness of CT-guided coil positioning technology in thoracoscopic resection of pulmonary nodules,and to focus on the factors affecting the complications(such as pneumothorax and hemorrhage)in the coil positioning surgery,as well as the factors affecting the surgical operation time of the lung nodule resection of the patients after the positioning surgery and the hospital days of the patients after the surgery,in order to avoid or reduce the occurrence of complications for the patients as much as possible To shorten the time of surgical operation and the length of hospital stay for pulmonary nodules.Methods 158 patients who underwent VATS surgery in Shangyu District Hospital of Traditional Chinese Medicine of Shaoxing City from January 2019 to July 2022 were selected retrospectively,among which 56 patients who did not use any positioning technology were referred to as the non-positioning group(non-positioning group,n=56);102 VATS patients who used CT-guided coil positioning technology were called positioning group(positioning group,n=102).The inter-group analysis between the positioning group and the non-positioning group was carried out first,and then the intra-group analysis was carried out on the influence of various influencing factors in the positioning group on complications,surgical operation time and postoperative hospitalization days.SPSS 23.0 statistical analysis software was used.Firstly,Shapiro-Wilk method is used to test the normality of numerical variables.Student t test is used for normal data,Mann-Whitney U test is used for non-normal numerical variables,and Chi-square test or Fisher exact probability method is used for categorical variables.In the process of correlation analysis,the first step is to carry out single factor logistic regression analysis on the variables,and the further step is to carry out multiple factor logistic regression analysis for those with P value less than 0.05.P<0.05 is statistically significant.crude OR is crude OR.Multifactor OR value(crude OR)is the corrected OR.An OR value greater than 1 is a risk factor,and an OR value less than 1 is a protective factor.Results In the inter-group analysis,there was no statistical difference between the two groups in general data(patient age,sex,etc.),but there was a statistical difference between the two groups in terms of bleeding during surgery and the number of days in hospital after surgery(P<0.05).In the intra-group analysis of the positioning group,the puncture time(OR=1.07,P=0.04),emphysema(OR=3.87,P=0.03),patient position(OR=8.00,P<0.01),puncture times(OR=1.23,P=0.03)and puncture depth(OR=1.22,P<0.01)in the univariate analysis were related to the occurrence of pneumothorax after coil positioning;The patient’s age(OR=0.93,P=0.02),puncture time(OR=1.14,P<0.01),number of localized nodules(OR=3.73,P<0.01),number of punctures(OR=1.36,P<0.01)and depth of punctures(OR=1.16,P=0.02)were related to intrapulmonary hemorrhage;Distance from the end of the coil to the pleura(β=2.64,P=0.03),emphysema(β=58.57,P<0.01),patient position(β=-25.91,P=0.03).Number of punctures {β=-4.06,P=0.04)and puncture depth(β=4.01,P<0.01)Related to surgical operation time;Patient age(β=0.06,P<0.01).Whether there are blood vessels in the range of pulmonary nodules(β=1.37,P=0.01),emphysema(β=2.04,P<0.01).Depth of puncture(β=0.14,P<0.01)Related to the number of days in hospital after surgery;Finally,binary logistic multifactor analysis was performed to analyze the depth of puncture needle(OR=1.23,P<0.01)and the patient’s position(OR=24.66,P<0.01)as independent risk factors for pneumothorax after micro-coil positioning operation;The age of patients(OR=0.91,P=0.02),puncture time(OR=1.19,P=0.02)and puncture depth(OR=1.26,P<0.01)were independent risk factors for postoperative intrapulmonary hemorrhage after micro-coil localization;Emphysema(β=46.05,P<0.01),patient position(β=-25.91,P=0.02)and the distance from the end of the coil to the pleura(β=2.36,P=0.04)is an independent risk factor for surgical operation time;Patient age(β=0.04,P=0.04).Whether there are blood vessels in the range of pulmonary nodules(β=1.20,P=0.02)and emphysema(β=1.28,P=0.04)is an independent risk factor for the length of hospital stay after surgery.Conclusion The positioning group can reduce the bleeding during surgery and the number of days in hospital after surgery compared with the non-positioning group.The deeper the puncture needle is inserted during positioning,the greater the risk of pneumothorax.The risk of pneumothorax in the patient’s lateral position is significantly higher than that in the supine position.The longer the puncture time and the deeper the puncture,the greater the risk of intrapulmonary hemorrhage.Patients with a history of emphysema,prone position during positioning,and the greater the distance from the end of the coil to the pleura,the longer the surgical operation time.The older the patient is,the more blood vessels are in the range of pulmonary nodules and the patient has a history of emphysema,the longer the hospital stay after surgery.