Clinical Application Of Supplement CT-guided Hookwire Placement For Localising Solitary Pulmonary Nodules Lesions At "Blind Areas"

Objective: Traditional CT-guided Hookwire localization of solitary pulmonary nodule(SPN)is widely used in clinical practice.However,for special nodules,Hookwire placement has "blind areas",which is mostly located in areas covered by the shoulder blades and ribs.This paper summarizes the supplement CT-guided Hookwire placement of the team of Professor Jiang Wenjun from the Department of Thoracic Surgery,the Fourth Affiliated Hospital of China Medical University,and the clinical application in the treatment of solitary pulmonary nodules by video-assisted thoracoscopic surgery.Methods: A retrospective analysis of 13 SPNs from 13 patients who were admitted Department of Thoracic Surgery,the Fourth Affiliated Hospital of China Medical University from January 2017 to December 2018,all SPNs were located in areas covered by the scapula.The localization method were performed by the supplement CT-guided Hookwire placement,and analyse the success rate of positioning,complications and factors affecting complications,time of wedge resection of lung,intraoperative blood loss,pathological results and other related indicators.Results: The success rate of localization in 13 patients was 92.3%(12/13),and the complication rate was 15.4%(2/13).1 case of micropneumothorax and 1 case of pulmonary perihematomal.There were no serious complications such as hemothorax and air embolism in all patients.After 13 patients underwent the supplement CT-guided Hookwire placement,they underwent single-hole thoracoscopic surgery to complete the resection of the lesion without transposition.The time of wedge resection of lung was16-47 min with an average time of 20.25 ± 3.15 min.There were 3 cases of primary lung cancer,1 case of lung metastasis,7 cases of atypical adenomatoid hyperplasia,1 case of carbon deposition with fibrous tissue hyperplasia,and 1 case of lymph node disease.After13 cases of pulmonary nodules with wedge resection,the distance between the tissue margin and the edge of the lesion was measured to be 2.2-3.1 cm,and the average distance was 2.4 cm.The deviation distance between the suture mark on the lung surface and the actual lesion is 0.2-0.9cm,and the average deviation distance is 0.5cm.Conclusion: The supplement CT-guided Hookwire placement has certain advantages for the location of the SPN in the "blind areas" of the lung(ie,areas covered by the shoulder blades and ribs).To some extent,it makes up for the shortcomings of other positioning methods for such SPN positioning.The positioning method has high success rate and low complication rate,and has certain clinical value.