| OBJECTIVE:To evaluate the safety and advancement of CT-guided preoperative localization of medical glue,and the feasibility and clinical value of early intervention in thoracoscopic surgery for pulmonary ground-glass nodules.METHODS:This study is divided into two parts: single nodule thoracoscopic resection and multiple nodule thoracoscopic resection according to the the number of nodules located and resected under thoracoscope.1.Study on video-assisted thoracoscopic resection of single nodule: collected patients whose chest CT showed pulmonary ground glass nodules and underwent video-assisted thoracoscopic resection of single nodule in the Second Hospital of Jilin University from January 2017 to March 2019,according to whether or not CT-guided medical glue was used for preoperative localization,the patients were divided into localization group and non-localization group.A total of 100 patient data were collected,including 60 patients in localization group with CT-guided medical glue before 1 to 3 hours and 40 patients in non-localization group,statistic of the success rate,accuracy rate and complications related to preoperative localization using medical glue,to compare the non-localization group with locatization group in the number of accurate resection of lesions cases,the time taken to resect nodules,the days of hospitalization after operation,total hospitalization expenses,intraoperative accidents and postoperative complications.The influence of nodule size,nodule nature,nodule location,nodule distance from pleura and other factors on accurate resection of nodules are analyzed and statistics of postoperative pathology of all patients were collected.2.Study on video-assisted Thoracoscopic resection of multiple nodules: collected patients whose chest CT showed two or more ground glass nodules and underwent simultaneousmultiple nodule thoracoscopic surgery after CT-guided medical glue localization at thoracic surgery department in the Second Hospital of Jilin University from January2017 to March 2019.A total of 63 ground glass nodules were collected from 29 patients.statistics of patients' general data,the success rate,accuracy rate and complications related to preoperative localization using medical glue,average hospital stay and postoperative complications after thoracoscopic surgery,and compared with the patients who underwent thoracoscopic surgery for single nodule after CT-guided medical glue localization,statistics of postoperative pathology of all patients were collected.RESULTS:1.Study on video-assisted thoracoscopic resection of single nodule: 60 patients underwent CT-guided medical glue localization before operation,all patients could successfully reach the localization nodule during operation,the localization success rate was 100%,and the accuracy rate was 100%,the average positioning time was15.46±4.93 min,pneumothorax occurred in 7 patients(11.67%),pulmonary hemorrhage occurred in 4 patients(6.67%),and irritant cough occurred in 2 patients(3.33%).Compared with the non-localization group,there is no significant differences in general informationthe,the success rate of precise resection was higher(100% vs67.5% p < 0.01),the time required for resection of pulmonary nodules was shorter(41.7±21.7 Min vs 66.0±38.5 Min p = 0.001),and the days of hospitalization after operation was shorter(6.4±0.29 vs 7.2±0.35 p = 0.047),the overall cost of hospitalization was less(54694.17±14467.15 vs 64690.38±14788.91 p = 0.001),there was no significant difference between the two groups in postoperative complications(8.33% vs 12.50% p = 0.496).The size of nodules,the nature of nodules,the distance between the nodules and the pleura and the location of the nodules were analyzed,it was found that the nature of nodules and the distance between the nodules and the pleura were two main risk factors.A total of 100 patients underwent thoracoscopic resection of a single lung nodule and all patients had definite pathological diagnosis,including 11 benign nodules(11%)and 89 malignant nodules(89%),of which 87%were primary lung cancer and all were adenocarcinoma of lung.2.Study onvideo-assisted thoracoscopic resection of multiple nodules:A total of 63 lung nodules in 29 patients were located and underwent simultaneous lobectomy and lobectomy through video-assisted thoracoscopic surgery,all 63 nodules were successfully located,with a success rate of 100%,the average positioning time was 24.34±11.32 min,all patients were able to reach the location colloidal particles and successfully achieved accurate location resection,with a positioning accuracy rate of 100%.,five patients(17.24%)had pneumothorax and 3 patients(10.34%)had pulmonary hemorrhage after the location was completed,no further special treatment is required,compared with the localization of a single nodule,the localization operation takes a long time(24.34±11.32 min vs 15.46±4.93 min p < 0.01),but there is no significant difference in the success rate,accuracy rate and overall complications of localization.No accident occurred in all patients during the operation,postoperative complications occurred in 5 patients(17.24%)after the operation,after treatment the patients improved and were discharged without perioperative death.the average postoperative hospital stay of thoracoscopic resection of multiple nodules was longer than that of thoracoscopic resection of single nodule(8.03±3.11 vs 6.4±0.29 P<0.01),there was no significant difference in overall postoperative complications(P=0.212).Postoperative pathological results showed that of the 63 nodules removed,13 cases(20.63%)were benign nodules and 50 cases(79.37%)were malignant nodules,which were primary lung adenocarcinoma.CONCLUSION:1.CT-guided preoperative localization of medical glue has the advantages of high success rate,high safety,and ideal clinical effecty in preoperative localization of single and multiple nodules,moreover the operation is simple,the price is low and the operation time can be chosen independently,so it is worthy of clinical application.2.CT-guided preoperative localization with medical glue can assist the location of the lesion quickly and accurately under thoracoscopycan,improve the success rate of precise resection of lung ground-glass nodules by thoracoscopic surgery,and reduce the time of thoracoscopic surgery and postoperative hospital stay which can save the total cost of hospitalization and has important clinical value for assistedthoracoscopic surgery.3.The nature of ground-glass nodules and the distance between the nodules and the pleura are two independent risk factors for accurate resection.4.In the single nodule resection study,87% of the nodules were early primary lung cancer,and in the multiple nodule resection study,79.37% of the nodules were concurrent primary lung cancer,it is suggested that it is necessary and feasible to perform accurate resection of suspicious GGN early detected by CT,which provides a good means for early diagnosis and treatment of lung cancer. |
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