[Advancement of Common Localization of Solitary Pulmonary Nodules for Video-assisted Thracoscopic Surgery]

Application of three-dimensional computed tomography bronchography and angiography in thoracoscopic anatomical segmentectomy of the right upper lobe: A cohort study

Objective

Three-dimensional computed tomography bronchography and angiography (3D-CTBA) can provide detailed imaging information for pulmonary segmentectomy. This study aimed to investigate the safety and effectiveness of 3D-CTBA guidance of anatomical segmentectomy of the right upper lobe (RUL).

Methods

This was a retrospective analysis of anatomical segmentectomy of the RUL at the Thoracic Surgery Department of the Fourth Hospital of Hebei Medical University from December 9, 2013, to June 2, 2021. Preoperatively, all patients underwent contrast-enhanced CT of the chest (to determine the size of the pulmonary nodule) and a lung function test. 3D-CTBA has been performed since 2018; patients with vs. without 3D-CTBA were compared. Segmentectomy was performed according to nodule location.

Results

Of 139 patients (46 males and 93 females, aged 21–81 years), 93 (66.9%) completed single segmentectomy, 3 (2.2%) completed single subsegmentectomy, 29 had combined subsegmentectomy, 7 had segmentectomy combined with subsegmentectomy, and 6 had combined resection of two segments. Eighty-five (61.2%) patients underwent 3D-CTBA. 3D-CTBA cases had decreased intraoperative blood loss (67.4 ± 17.6 vs. 73.1 ± 11.0, P = 0.021) and shorter operation time (143.0 ± 10.8 vs. 133.4 ± 20.9, P = 0.001). 3D-CTBA (Beta = −7.594, 95% CI: −12.877 to −2.311, P = 0.005) and surgical procedure (Beta = 9.352, 95% CI: 3.551–15.153, P = 0.002) were independently associated with intraoperative blood loss. 3D-CTBA (Beta = −13.027, 95% CI: −18.632 to 17.422, P < 0.001) and surgical procedure (Beta = 7.072, 95% CI: 0.864–13.280, P = 0.026) were also independent factors affecting the operation time.

Conclusion

Preoperative use of 3D-CTBA to evaluate the pulmonary vessels and bronchial branch patterns of the RUL decreased blood loss and procedure time and so would be expected to improve the safety and effectiveness of thoracoscopic segmentectomy.

Clinical Analysis of Video-Assisted Thoracoscopic Surgery for Resection of Solitary Pulmonary Nodules and Influencing Factors in the Diagnosis of Benign and Malignant Nodules

Purpose

This is a retrospective research comparing the clinical outcomes of single-hole versus multi-hole video-assisted thoracoscopic surgical (VATS) resection for solitary pulmonary nodules (SPN) and examining the factors influencing the diagnosis of benign and malignant pulmonary nodules.

Method

We collected the clinical data, surgical status, outcomes, and corresponding imaging features of 317 patients with SPN who were surgically resected by VATS and diagnosed as benign or malignant by pathology in our hospital from January 2019 to December 2021.

Result

Among the 317 patients, 124 (39.12%) underwent single-port VATS and 193 (60.88%) underwent multiple-hole VATS. All patients were grouped according to the different surgical methods, and their postoperative indicators were statistically analyzed. The results showed that neither the single-port VATS group nor the multi-port VATS group had any serious adverse events such as death during the perioperative period. The average operation time, intraoperative blood loss, drainage tube indwelling time, and postoperative hospital stay were significantly lower in the two groups. Statistics of postoperative pathological diagnosis showed that 98 cases (30.91%) of all nodules were benign nodules and 219 cases (69.09%) were malignant nodules, and a further single-multivariate analysis showed that age, nodule maximum diameter, lobular sign, burr sign, vascular cluster sign, and pleural depression sign were independent relevant factors for the diagnosis of benign and malignant nodules.

Conclusion

VATS is less invasive and has fewer complications and is of great clinical value for both diagnosis and treatment of benign and malignant SPN. Age, maximum nodal diameter, lobar sign, burr sign, vascular set sign, and pleural depression sign were independent correlates affecting the diagnosis of benign and malignant SPN, which reminds that great attention should be paid to patients who are older and have risk factors on imaging, and early and timely active treatment or close follow-up should be carried out.

[Preoperative Pulmonary Nodule Localization Methods:A Comparison of Microcoil and Sclerosing Agent]

背景与目的

肺内小结节往往难以进行胸腔镜术中定位，需要术前计算机断层扫描（computed tomography, CT）引导经皮穿刺定位辅助，本研究旨在比较两种不同定位材料即微弹簧圈和硬化剂（聚桂醇）定位的效果及相关并发症，评价优劣。

方法

回顾性分析术前CT引导经皮穿刺定位患者371例，根据采用的不同定位材料分为：微弹簧圈组（microcoil group）167例，定位结节196枚、硬化剂组（sclerosing agent group）204例，定位结节239枚。统计分析两组定位效果、并发症、病理资料及手术方案等相关资料。

结果

微弹簧圈组定位失败率（2.4%）高于硬化剂组（0.5%）（P=0.011），硬化剂定位耗时明显短于微弹簧圈组[（18.78±6.91）min vs（11.99±3.77）min, P=0.000]，但微弹簧圈组较硬化剂组选择定位结节与胸膜间距离更深[（9.59±8.62）mm vs（8.13±6.49）mm, P=0.002]。总体并发症上微弹簧圈组显著高于硬化剂组（P=0.000），其中以气胸为主，通过相关危险因素分析提示不同定位方法是独立危险因子。手术方式以楔形切除为主，病理结果以非浸润性病变为主。

结论

微弹簧圈与硬化剂均是良好的术前定位材料，聚桂醇硬化剂较之微弹簧圈定位失败率更低、并发症更少，定位时长更短，操作简便且费用低廉，值得推广。