| Part 1.Comparison of short-term effects for Single Utility Port VATS anatomic pulmonary segmentectomy and lobectomy in early non-small cell lung cancer[Objective]As the high detection rate of early stage lung cancer,the total thoracoscopic segmentectomy gradually gain more focus and such a procedure has gradually increased clinically.This study compared the short-term index of single utility port VATS for lung segmentectomy and lobectomy in early NSCLL to explored the safety and feasibility in two ways.[Methods]Retrospective analysis of 62 patients with early non-small cell lung cancer in the First Hospital of Suzhou University from June 2017 to October 2018,including 28 patients undergoing segmentectomy resection and 34 patients for lobectomy.Comparing two group operation time,intraoperative blood loss,number of lymph nodes removed during operation,chest tube indwelling time,postoperative chest drainage,postoperative complications,hospital stay,number of used nail cartridges,hospitalization expenses,postoperative pathological results and follow up information.[Results]Both groups of patients successfully completed the operation,and the clinical characteristic data were comparable.The operation time[(192.1±46.8)min VS(187.2±86.6,P=0.792)],total drainage after operation[(908.39±515.38)ml VS(1603.68±1368.77)ml,p<0.001],drainage tube outtime[(4.7±1.8)day VS(6.1±2.0)day,p=0.028],postoperative hospital stay time[(6.1±2.0)days VS(7.8±3.8)days,p=0.047].Intraoperative blood loss[(84.19±27.90)ml VS(90.47±33.85)ml,p=0.57],lymph node dissection number[(2.3±1.8)VS(10.7±6.0),p<0.001],using nail cartridge[(3.5±1.5)个 VS(4.4±1,5)],hospitalization costs[(6.1±1.1)ten-thousand VS(6.5±1.7)ten-thousand,p=0.366].There were no statistically significant differences between the two groups in the incidence of postoperative complications at 14.3%and 14.7%.For the two groups,the average follow-up time was 9 months.There was no recurrence and metastasis of malignant nodules,and no tumor-related death occurred.[Conclusion]:Both single utility port VATS anatomical segmental resection and lobectomy can achieve good short-term results.The operation time of segmentectomy is equivalent to lobectomy time.but the indexes of drainage,hospitalization time,and drainage tube extraction time are better.More lymph nodes removed in lobectomy.The operation cost and postoperative complications didn’t increase.Therefore,in the short-term effect,segmental resection and lobectomy are both feasible in the treatment of early non-small cell lung cancer,and segmental resection is superior in rapid rehabilitation,and it has great clinical application value.Part2.Clinical application of preoperative hookwire localization combined with single-hole thoracoscopic treatment for ground glass nodules[Objective]To explore the application of preoperative hookwire localization combined with single port thoracoscopic surgery in the treatment of lung ground glass nodules.To summarize the method useing hookwire localization.To share the techniques of hookwire localization combined with single port thoracoscopic pulmonary nodule resection.[Methods]A total of 55 pulmonary nodules in 47 patients from April 2018 to October 2018 were collected.CT-guided hookwire was used to before thoracoscopic pulmonary nodule resection.The nodules’ nature,diameter,location time,complications,interval time,removal time of nodules,and pathological results were collected and analyzed.[Results]1)Positioning index results:47 patients with 55 nodules(15 males and 32 females),including 3 solid pulmonary nodules(SPNs),25 pure ground glass nodules(pure ground glass nodules,pGGNs),27 mixed ground-glass nodules(mGGNs).lesion diameter 6mm-26mm(mean diameter 12.6mm),focal distance from the pleura vertical distance 0 mm-32mm(average 10.7mm),One of the patients failed the localization(the nodule was removed by anatomical relationship in operation).The average CT imaging time was 13.8 min(8 min-28 min),the average waiting time before surgery was 28.5 min(20-57 min),the average resection time was 29.2min(10min-188min).2)Complications:1 case of localization failure(resection of nodules based on anatomical relationship),the success rate of nodule resection was 100%,including 2 cases of segmentectomy,40 cases by single hole surgery(85.1%).The locating needle was removed in 8 cases(the lesion was accurately removed after observing the visceral puncture point).4 cases of micro-pneumothorax,2 cases of intercostal artery hemorrhage(1 case of bleeding more than about 25ml).1 case of hemoptysis,the amount is about 5ml.One patient had significant cough.There were no complications such as neurogenic shock and pleural reaction.3)Pathological results(subject to postoperative pathology):In 25 pGGNs,there were 1 case of adenocarcinoma in situ(AIS),18 cases of minimally invasive adenocarcinoma(MIA),4 cases of invasive adenocarcinoma(IA),2 case of benign lesions.Of the 27 mGGNs,18were MIA,6 were IA,and 3 were benign.One of the three SPNs including one IA and the other two was benign.One case of mGGO showed postoperative pathological progression,from MIA to invasive adenocarcinoma(alveolar-based).(Micro-invasive adenocarcinoma and in situ microinvasive adenocarcinoma was expressed as microinvasive adenocarcinoma)[Conclusion]CT-guided hookwire lung nodule location was high accuracy and less complications.Preoperative hookwire positioning combined with single-hole thoracoscopic small nodule resection is accurate,safe and minimally invasive.Through precise,we can effectively avoid risks and reduce complications. |
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