A Short-Term Clinical Effects Comparative Study Between Target-Segment Artery Drainage Area Localization Resection And Anatomical Segmentectomy

Objectives:To compare the short-term clinical effects of Target-segment artery drainage area localization resection and anatomical segmentectomy,to explore the scope of application and clinical benefits of Target-segment artery drainage area localization resection,and to analyze the common clinical tests and imaging indicators of patients after thoracoscopic sublobectomy,so as to provide bases for relevant clinical research.Methods:Retrospectively collected patients who were admitted to the Department of Geriatric Thoracic Surgery,The First Affiliated Hospital of Kunming Medical University from January 2020 to August 2022,The basic clinical features(name,sex and age),imaging features and postoperative pathological features of pulmonary nodules were recorded in each patient.According to the inclusion and exclusion criteria,145 patients who completed thoracoscopic sublobe resection were finally included,including 76 patients with anatomical segmental resection(control group)and 69 patients with Target-segment artery drainage area localization resection(experimental group).Collect and record the blood routine and blood biochemical test data of patients in both groups one day before and one day after operation,Collect the data of CRP,PCT and blood routine test on POD1 and POD 3,and thoracic drainage volume on 1-3 days after operation.The chest X-ray results of patients 1 day after operation and CT image data 1 month after operation were read and recorded.By searching the hospitalization data of patients and returning by telephone,the postoperative recovery of patients was obtained.Through clinical records to collect operation time,time of pulling out thoracic drainage tube and postoperative adverse events.Results: 1.Comparison of general data of patients:There was no significant difference in age,sex ratio,basic disease,severe smoking,surgical site distribution,lymph node dissection degree distribution,nodule diameter,nodule imaging distribution,final pathological results between two groups,but has significant difference in the number of patients with mild smoking(p<0.001).2.Comparison of test indexes:There was no statistically significant difference in preoperative albumin(ALB)between the target segment arterial drainage area localization resection group and the anatomical segmental pulmonary resection group,while the preoperative Hb(p=0.023)difference was statistically significant,but both were within the normal clinical reference range.There was no statistically significant difference in postoperative albumin(ALB)and hemoglobin(Hb)between the two groups,but there was a statistically significant difference in intraoperative bleeding(p=0.023)between the two groups.The difference in preoperative white blood cells(WBC)between the two groups was statistically significant,but both were within the reference range of clinical normal values.There was no significant difference in WBC between the two groups on POD1 and POD3;The difference in CRP between the two groups on POD1(p=0.041)was statistically significant,while the difference in CRP on POD3 was not statistically significant;There was a statistically significant difference in PCT between the two groups on POD1(p=0.034),but there was no statistically significant difference in PCT on POD3.3.Comparison of other clinical indicators: there was a significant difference between the two groups in the amount of thoracic drainage on POD1(p=0.031);but was no difference in the amount of thoracic drainage on POD2,and POD3.there was no significant difference in the distribution of the time periods of pulling out the chest tube,the proportion of the number of different manifestations on the chest radiograph on POD1,the proportion of the number of different manifestations on the chest CT in the 1st month after operation,and the total number of adverse events after operation between two groups.4.There was a statistically significant difference between Target-segment artery drainage area localization resection and anatomical segmentectomy in operation time(p<0.001)and hospitalization cost(p=0.002),but there was no statistically significant difference in postoperative hospitalization time.5.Analysis of other subgroups: among the T≤2cm,CTR≤0.25 nodules(n=119),and did not contain the vacuolar sign,the final pathological result was invasive adenocarcinoma(IAC)(n=23)and other pathological types(n=96).After grouping,it was found that the two groups had significant differences in patient age(p=0.002)and nodule diameter(p<0.001).Through logistic regression analysis,it was found that the diameter of the nodule was an independent risk factor leading to the final pathological result being IAC(OR=1.226,1.08～1.50,p=0.005).using T=8.5mm as the cutoff value,the sensitivity and specificity for judging invasive lung adenocarcinoma were65.2% and 83.3%.After grouping the patients with postoperative complications(n=10)and without complications(n=135),there was no statistical difference in the operation time and age of the patients in the two groups.There was a statistical difference in the proportion of patients with chronic diseases between the two groups(p=0.014).Conclusions: 1.There was no significant difference in postoperative complications and short-term recovery between target segment arterial drainage area localization resection and anatomical segmental resection,but the former had shorter surgical time,less hospital expenses,and less postoperative inflammatory stress.2.In the cases included in this study,the sensitivity and specificity for judging invasive lung adenocarcinoma were 65.2% and 83.3%,using T=8.5mm as the cutoff value,for those nodules that met the requirements of T ≤ 2cm,CTR ≤ 0.25,and did not contain the vacuolar sign.