| BackgroundCT guided Hook-wire localization has been widely used in the localization of pulmonary nodules,but there are still some shortcomings.The pulmonary ground glass nodules(GGN)is a clinical technical difficulty.This study was conducted through clinical case analysis to discuss the clinical application and safety of CT guided Hook-wire localization for GGN and thoroughly investigate the influencing factors of complications of Hook-wire localization,in order to find a better method for GGN localization and prevent the occurrence of complications.ObjectiveTo retrospectively analyze the clinical and imaging data of patients with GGN underwent CT-guided Hook-wire localization technique,aiming to compare the effect and complication of single Hook-wire and double Hook-wire localization and explore the risk factors related to complications.MethodsThe clinical data of 164 patients with GGN(198 ground glass nodules in total),who underwent CT guided Hook-wire positioning before VATS,were collected and analyzed in Zhengzhou People’s Hospital from January 2019 to June 2020.The basic clinical data and imaging data of all patients were collected,including age,gender,body mass index(BMI),smoking history,history of pulmonary disease,numbers of GGN,GGN location,GGN diameter,distance from the GGN to the parietal pleura,pathological type of GGN;The relevant data of Hook-wire localization include:patient position,positioning needle type,insertion angle,whether or not the needle was close to the ribs,needle depth in the subcutaneous tissue,numbers of localization,time of localization,location success rate and the incidence of postoperative pneumothorax and pulmonary hemorrhage.(1)164 GGN patient were divided into single Hook-wire group and double Hook-wire group according to the different positioning needle types.The differences in clinical data and Hook-wire data between the two groups were compared by t-test and chi-square test to evaluate the location success rate and the incidence of complications;(2)All patients were divided into different subgroups,according to whether the patients had postoperative pneumothorax or intrapulmonary hemorrhage.The differences in clinical data and Hook-wire data between the two groups were compared by t-test and chi-square test,respectively.Multivariate logistic regression was used to analyze the independent risk factors for postoperative pneumothorax or intrapulmonary hemorrhage.Results(1)The location success rate of 164 GGN patients was 97.56%,the incidence of pneumothorax and intrapulmonary hemorrhage were 30.48%and 23.17%,respectively.(2)The location success rate of the single Hook-wire group was 92.50%,significantly lower than that of the double Hook-wire group(99.19%,χ~2=5.695,P=0.045).The incidence of pneumothorax and intrapulmonary hemorrhage in the single Hook-wire group were 17.50%and 10.00%,both significantly lower than that in the double Hook-wire group 35.48%and 27.42%(P<0.05).And there was no statistical difference in other data between the two groups(P>0.05).(3)The results of univariate analysis showed that the history of pulmonary disease,numbers of GGN,positioning needle type,whether or not the needle was close to the ribs,numbers of localization,patient position,time of localization and needle depth in the subcutaneous tissue might be related to the occurrence of pneumothorax(P<0.05).(4)Logistic multivariate regression analysis showed that history of pulmonary disease(OR=3.782,95%CI=1.663-8.600,P=0.002),puncture needle close to the ribs(OR=3.081,95%CI=1.041-9.116,P=0.042),multiple localization(OR=6.518,95%CI=1.241-34.234,P=0.027)and longer localization time(OR=4.181,95%CI=1.411-12.383,P=0.010)were independent risk factors for pneumothorax.(5)Univariate analysis showed that the history of pulmonary disease,distance from the GGN to the parietal pleura,positioning needle type,numbers of localization,time of localization and needle depth in the subcutaneous tissue might be related to the occurrence of intrapulmonary hemorrhage(P<0.05).(6)Logistic multivariate regression analysis showed history of lung disease(OR=2.551,95%CI=1.128-5.769,P=0.024),distance from the GGN to the parietal pleura(OR=2.265,95%CI=1.005-5.105,P=0.049),positioning needle type,double Hook-wire location(OR=4.768,95%CI=1.397-16.274,P=0.013),multiple localization(OR=4.627,95%CI=1.118-19.156,P=0.035)and needle depth in the subcutaneous tissue(OR=2.459,95%CI=1.045-14.519,P=0.027)were independent risk factors for intrapulmonary hemorrhage.Conclusions(1)CT-guided double Hook-wire localization for GGN can reduce the risk of Hook-wire locating failure,but increase the incidence of complications.(2)The risk factors of pneumothorax include the history of pulmonary disease,puncture needle close to the ribs,numbers of location and time of localization.(3)The occurrence of intrapulmonary hemorrhage is related to the history of pulmonary disease,distance from the GGN to the parietal pleura,positioning needle type,numbers of localization,and needle depth in the subcutaneous tissue.In conclusion,CT guided Hook-wire localization is a safe and effective preoperative localization methods for the pulmonary GGN.Although minor complications often occurred,lated to CT-guided preoperative Hook-wire placement often occurred,most of them effectively controlled and no require special treatment. |
PDF Full Text Request