| Background:With the popularity of high-resolution CT(HRCT)scanning,more and more subcentimeter pulmonary small nodules(SPSNs)have been detected.With the advancement of video-assisted thoracoscopic surgery(VATS)and Da Vinci robotic surgery technology,pulmonary wedge resection and segmentectomy have become an important means of diagnosis and treatment of small pulmonary nodules.However,most intrapulmonary nodules are difficult to accurately localization during surgery due to their small size,fewer solid components,and low differentiation from normal lung tissue.Therefore,preoperative localization of pulmonary nodules is increasingly widely used in clinical practice.Currently,the commonly used preoperative localization methods are CT guided percutaneous puncture Hookwoire localization and Electromagnetic Navigation Bronchoscopy(ENB)localization,which improve the accuracy of intraoperative nodule localization,achieve more accurate resection,and allow patients to lose less lung tissue to retain more lung function.At present,although many studies have compared ENB and CT guided preoperative auxiliary localization,the safety and effectiveness of ENB and guided localization under CT are still controversial,especially for multiple nodules.Therefore,the present study conducted a comparative analysis of the safety and effectiveness of ENB and CT on the preoperative adjuvant localization of peripheral pulmonary nodules.Methods:A retrospective research was conducted to analyze the patients who underwent Video-assisted Thoracoscopic Surgery(VATS)to resect pulmonary nodules and used ENB assisted localization or CT assisted localization in the chest surgery of Qilu Hospital,Shandong University from January 2019 to December 2022.Including the basic clinical characteristics of the patient,the time required for localization,the number of localized nodules,and the postoperative short-term recovery of the patient.Compare and analyze the security and effectiveness of the two localization methods.Results:307 pulmonary nodules in 224 patients were divided into two groups according to the localization method,the ENB assisted localization group and the CT assisted localization group.103 nodules in 62 patients received ENB assisted localization,and 204 nodules in 162 patients received CT guided localization.In ENB assisted localization group,all nodules were successfully located 100%(62/62),and all nodules were successfully located and resected without complications such as pneumothorax or hemothorax.The successful localization rate in the CT assisted localization group was 98%(159/162),with 3 patients having a dislocated positioning hook but still successfully resecting the lesion after seeing the bleeding point under thoracoscopy,no patients had complications such as pneumothorax or hemothorax.All patients underwent thoracoscopic subpulmonary lobectomy with no intraoperative conversion to thoracotomy.The diameter of nodules in ENB assisted localization was smaller than that in CT assisted localization(0.721 ± 0.336cm vs 0.938 ±0.400cm,p<0.01).and the number of nodules in ENB assisted localization was more than that in CT assisted localization(1.66 ± 0.886 vs 1.26 ± 0.493,p<0.01).The localization time in the ENB assisted localization group was longer than that in the CT assisted localization group(35.08 ± 1 1.505 min vs 26.09± 8.267 min,p<0.01).The postoperative catheterization time(4.19 ± 1.854d vs 4.99 ± 2.547d,p=0.026)and postoperative hospitalization time(6.46 ±2.352d vs 7.38±2.612d,p=0.019)in the ENB assisted localization group were both shorter than those in the CT assisted localization group.At the same time,subgroup analysis was conducted based on the number of nodules,and statistics were made for single and multiple nodules.For single nodules,the diameter of nodules in the ENB assisted localization group was smaller than that in the CT assisted localization group(0.80 ± 0.207 cm vs 0.98 ±0.359 cm,p<0.01).In terms of localization time,the ENB assisted localization group was higher than that in the CT assisted localization group(32.71±10.025 min vs 22.22±3.679 min,p<0.01).The postoperative catheterization time(3.86 ± 1.683 days vs 4.85±2.353 days,p=0.021)and postoperative hospitalization time(6.17 ± 2.382 days vs 7.24 ± 2.457 days,p=0.023)in the ENB assisted localization group were smaller than those in the CT assisted localization group.For multiple nodules,the diameter of nodules in the ENB assisted localization group was smaller than that in the CT assisted localization group(0.699 ± 0.414 cm vs 0.890±0.4262 cm,p<0.01).Conclusion:Both ENB assisted localization and CT assisted localization can better locate small peripheral pulmonary nodules;ENB assisted localization has significant advantages over CT assisted localization in locating the number and size of nodules,but ENB assisted localization requires longer localization time;ENB assisted localization can effectively shorten the postoperative catheterization time and postoperative hospitalization days,and accelerate the postoperative rehabilitation of patients;When the number of nodules is ≥2,there is no significant difference between ENB assisted localization and preoperative localization in localization time,the postoperative catheterization time and postoperative hospitalization time. |
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