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@#Objective To assess the clinical value of preoperative localization coupled with computed tomography (CT) three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection. Methods The clinical data of 30 patients of combined subsegmental/segmental resection in our hospital from December 2019 to October 2021 were retrospectively collected. There were 19 males and 11 females with the mean age of 56.4 (32.0-71.0) years. The pulmonary nodules were located by CT-guided injection of glue before operation. The three-dimensional reconstruction image and operation planning were carried out by Mimics 21.0 software. Results The operations were all successfully performed, and there was no conversion to open thoracotomy or lobectomy. The mean tumor diameter was 11.6±3.5 mm, the mean distance between the nodule and the visceral pleura was 13.6±5.6 mm, the mean width of the actual cutting edge was 25.0±6.5 mm, the mean operation time was 110.2±23.8 min, the mean number of lymph node dissection stations was 6.5±2.4, the mean amount of intraoperative bleeding was 50.8±20.3 mL, the mean retention time of thoracic catheter was 3.2±1.1 d, and the mean postoperative hospital stay was 4.5± 1.7 d. There was 1 patient of subcutaneous emphysema, 1 patient of atrial fibrillation and 1 patient of blood in sputum. Conclusion Preoperative CT-guided injection of medical glue combined with CT three-dimensional reconstruction of pulmonary bronchus and blood vessels is safe and feasible in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection, which ensures the surgical margin and reserves lung tissues.
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@#Objective To investigate the clinical efficacy of preoperative location of pulmonary nodules guided by electromagnetic navigation bronchoscopy (ENB). Methods Patients who received preoperative ENB localization and then underwent surgery from March 2021 to November 2022 in the Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were collected. The clinical efficacy and safety of ENB localization and the related factors that may affect the success of ENB localization were analyzed. Results Initially 200 patients were included, among whom 17 undergoing preoperative localization and biopsy were excluded and a total of 183 patients and 230 nodules were finally included. There were 62 males and 121 females with a mean age of 49.16±12.50 years. The success rate of navigation was 88.7%, and the success rate of ENB localization was 67.4%. The rate of complications related to ENB localization were 2.7%, and the median localization time was 10 (7, 15) min. Multi-variable analysis showed that factors related to successful localization included distance from localization site (OR=0.27, 95%CI 0.13-0.59, P=0.001), staining material (OR=0.40, 95%CI 0.17-0.95, P=0.038), and staining dose (OR=60.39, 95%CI 2.31-1 578.47, P=0.014). Conclusion ENB-guided preoperative localization of pulmonary nodules is safe and effective, and the incidence of complications is low, which can be used to effectively assist the diagnosis and treatment of early lung cancer.
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@# Objective To systematically evaluate the application effect of CT-guided Hook-wire localization and CT-guided microcoil localization in pulmonary nodules surgery. Methods The literatures on the comparison between CT-guided Hook-wire localization and CT-guided microcoil localization for pulmonary nodules were searched in PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang, VIP and CNKI databases from the inception to October 2021. Review Manager (version 5.4) software was used for meta-analysis. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of studies. Results A total of 10 retrospective cohort studies were included, with 1 117 patients including 473 patients in the CT-guided Hook-wire localization group and 644 patients in the CT-guided microcoil localization group. The quality of the studies was high with NOS scores>6 points. The result of meta-analysis showed that the difference in the localization operation time (MD=0.14, 95%CI −3.43 to 3.71, P=0.940) between the two groups was not statistically significant. However, the localization success rate of the Hook-wire group was superior to the microcoil group (OR=0.35, 95%CI 0.17 to 0.72, P=0.005). In addition, in comparison with Hook-wire localization, the microcoil localization could reduce the dislocation rate (OR=4.33, 95%CI 2.07 to 9.08, P<0.001), the incidence of pneumothorax (OR=1.62, 95%CI 1.12 to 2.33, P=0.010) and pulmonary hemorrhage (OR=1.64, 95%CI 1.07 to 2.51, P=0.020). Conclusion Although Hook-wire localization is slightly better than microcoil localization in the aspect of the success rate of pulmonary nodule localization, microcoil localization has an obvious advantage compared with Hook-wire localization in terms of controlling the incidence of dislocation, pneumothorax and pulmonary hemorrhage. Therefore, from a comprehensive perspective, this study believes that CT-guided microcoil localization is a preoperative localization method worthy of further promotion.
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@#Objective To study the feasibility and safety of CT-guided preoperative Hookwire localization of pulmonary nodules in clinical application. Methods Clinical data of 102 patients who were scheduled to undergo surgical treatment for pulmonary nodules from June 2015 to April 2020 in the North Ward of Thoracic Surgery Department of Ruijin Hospital were retrospectively analyzed. There were 38 males and 64 females, aged 23-82 (53.2±12.8) years. Results All 102 patients with pulmonary nodules underwent CT-guided preoperative Hookwire localization successfully, with a localization success rate of 100.0%. The localization time was 27.0 (11-67) min; the number of times to adjust the angle during the positioning process was 6.9 (3-14); the needle depth of the positioning needle was 41.5 (16.3-69.1) mm. A total of 48 (47.1%) patients had a small amount of bleeding in the lung tissue in the positioning area after positioning; 53 (51.9%) patients had a small amount of pneumothorax after positioning; 16 (15.7%) patients were found that the positioning needle completely shedded from the lung tissue in the subsequent surgery. One patient was transferred to open thoracotomy because of extensive dense adhesion in the thorax, and the remaining 101 patients were operated on under thoracoscopy. Postoperative pathology showed that 5 (4.9%) patients were adenocarcinoma in situ, 28 (27.5%) were microinvasive adenocarcinoma, 36 (35.3%) patients were invasive carcinoma and 32 (31.3%) patients were benign lesions. No patients had complications or adverse events related to preoperative positioning. Conclusion Pre-operative CT-guided localization of Hookwire intrapulmonary nodules is safe and effective, and can meet the intraoperative localization needs of thoracic surgeons in most clinical situations, and is not inferior to other preoperative localization methods currently used in clinics.
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@#Objective To compare the effectiveness and safety of preoperative lung localization by microcoil and anchor with scaled suture. Methods A total of 286 patients underwent CT-guided puncture localization consecutively between October 2019 and December 2020 in our hospital. According to the different methods of localization, they were divided into a microcoil group (n=139, including 49 males and 90 females, aged 57.92±10.51 years) and an anchor group (n=147, including 53 males and 94 females, aged 56.68±11.31 years). The clinical data of the patients were compared. Results A total of 173 nodules were localized in the microcoil group, and 169 nodules in the anchor group. The localization success rate was similar in the two groups. However, the anchor group was significantly better than the microcoil group in the localization time (8.15±2.55 min vs. 9.53±3.08 min, P=0.001), the pathological receiving time (30.46±14.41 min vs. 34.96±19.75 min, P=0.029), and the hemoptysis rate (10.7% vs. 30.1%, P=0.001), but the pneumothorax rate was higher in the anchor group (21.3% vs. 11.0%, P=0.006). Conclusion Preoperative localization of small pulmonary nodules using anchor with suture is practical and safe. Due to its simplicity and convenience, it is worth of promotion in the clinic.
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@#Objective To evaluate the safety and application value of three-dimensional reconstruction for localization of pulmonary nodules in thoracoscopic lung wedge resection. Methods The clinical data of 96 patients undergoing thoracoscopic lung wedge resection in our hospital from January 2019 to August 2020 were retrospectively reviewed and analyzed, including 30 males and 66 females with an average age of 57.62±12.13 years. The patients were divided into two groups, including a three-dimensional reconstruction guided group (n=45) and a CT guided Hook-wire group (n=51). The perioperative data of the two groups were compared. Results All operations were performed successfully. There was no statistically significant difference between the two groups in the failure rate of localization (4.44% vs. 5.88%, P=0.633), operation time [15 (12, 19) min vs. 15 (13, 17) min, P=0.956], blood loss [16 (10, 20) mL vs. 15 (10, 19) mL, P=0.348], chest tube placement time [2 (2, 2) d vs. 2 (2, 2) d, P=0.841], resection margin width [2 (2, 2) cm vs. 2 (2, 2) cm, P=0.272] or TNM stage (P=0.158). The complications of CT guided Hook-wire group included pneumothorax in 2 patients, hemothorax in 2 patients and dislodgement in 4 patients. There was no complication related to puncture localization in the three-dimensional reconstruction guided group. Conclusion Based on three-dimensional reconstruction, the pulmonary nodule is accurately located. The complication rate is low, and it has good clinical application value.
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@#Objective To investigate the preoperative localization of pulmonary glabrous nodules. Methods A total of 192 patients admitted to General Hospital of Northern Theater Command from April 2012 to September 2019 were selected for the study. There were 95 males and 97 females at an age of 56.47±11.79 years. All patients completed preoperative examination, and were divided into a positioning group (n=97) and a non-positioning group (n=95) according to whether the preoperative positioning was performed. And the surgical indicators between the two groups were compared. According to the substance of ground-glass opacity, they were divided into a pure ground-glass nodules group (n=23) and a mixed ground-glass nodules group (n=74) in the positioning group and a pure ground-glass nodules group (n=14) and a mixed ground-glass nodules group (n=81) in the non-positioning group . According to the size and distance of the nodules from the pleura and whether the nodules could be detected, the corresponding linear function was obtained. Results The operative time of methylene blue localization group was shorter than that of the no localization group. In the scatter plot, the corresponding diameter and depth of the nodules and the corresponding coordinate points which can be explored were described. And linear regression was performed on all the coordinate points to obtain the linear function: depth=0.648×diameter–1.446 (mm). It can be used as an indication for the preoperative localization of pure ground-glass nodules in Da Vinci robotic surgery. Linear function: depth=0.559 5×diameter+0.56 (mm). It can be used as an indication of preoperative localization of mixed ground-glass nodules in Da Vinci robotic surgery. Conclusion This equation can be used as a preoperative indication for clinical peripheral pulmonary ground-glass nodules.
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Objective To study the application of regional localization method in the thoracoscopic resection of small pulmonary nodule.Methods Sixty-eight cases of small pulmonary nodules were located by applying the small pulmonary nodules regional localization method,and the clinical effect was intraoperatively observed.The ROC curve was used to find the best node for the nodule maximum diameter and minimum distance from the pleural.Results The once successful localization was obtained in 65 cases with the success rate of 95.6％.The best node of the maximum diameter of small pulmonary nodules was 1.0 cm,and the shortest distance from the pleura was 1.3 cm.Conclusion The regional localization method in the thoracoscopic resection of small pulmonary nodule has high accuracy.
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In recent years,the detection rate of early lung cancer with microscopic lesions such as ground-glass nodules and sub-centimeter nodules (≤ 1 cm) has been significantly higher.For such lesions,early surgical intervention can effectively prolong the survival time of patients.But in the actual operation of these small lesions difficult to detect,which brought great difficulties to surgery.At present,clinically for such small lesions,usually in the preoperative CT-guided puncture positioning based on the implementation of surgical resection.This method of location there are trauma,complications and other shortcomings,so how to more precise positioning and labeling of lung lesions is a clinical problem to be solved urgently.In this paper,the localization and localization of lung lesions in recent years are reviewed,and the advantages and disadvantages of various methods and materials are summarized and analyzed.
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In recent years,the detection rate of early lung cancer with microscopic lesions such as ground-glass nodules and sub-centimeter nodules (≤ 1 cm) has been significantly higher.For such lesions,early surgical intervention can effectively prolong the survival time of patients.But in the actual operation of these small lesions difficult to detect,which brought great difficulties to surgery.At present,clinically for such small lesions,usually in the preoperative CT-guided puncture positioning based on the implementation of surgical resection.This method of location there are trauma,complications and other shortcomings,so how to more precise positioning and labeling of lung lesions is a clinical problem to be solved urgently.In this paper,the localization and localization of lung lesions in recent years are reviewed,and the advantages and disadvantages of various methods and materials are summarized and analyzed.
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Objective To study CT-guided localization of additional pulmonary nodules with microcoils prior to video-assisted thoracoscopic surgery (VATS) resection in patients with suspected lung cancer.Methods Eleven patients suspected lung cancer underwent preoperative microcoils localization towards additional small pulmonary nodules.The head of microcoil was pinpointed adjacent to the target nodule while its end tail remained above the visceral pleura.VATS were performed within 24 hours, and comprehensive assessments were conducted according to surgical and pathological outcomes of primary and additional lesions, and suitable surgical processes were followed.Results All 11 localizing pulmonary nodules (4-15 mm in diameter) were successfully removed after VATS, 9 microcoils'' end tails of which were placed above visceral pleural surface.There were no serious complications related with localizing procedure.Other 16 lesions including 11 primary ones were resected.The surgical and pathological outcomes for lung lesions were utterly assessed.Conclusion Microcoil preoperative localization provides helpful orientation for complete resection and assessment of multiple pulmonary lesions in patients with suspected lung cancer.
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Objective To explore the neural function analysis based on PET/CT imaging for the MRI negative localization in patients with refractory epilepsy.Methods 85 cases of drug refractory epilepsy patients (male 47,female 38,M/F:1.2 ︰ 1;age range from 6-35 years old),receiving head PET/CT conventional imaging in the interphase,compared to the normal PET cerebral metabolic databases.Surgery was carried out on the patients who with unilateral lobe of the brain,the efficacy was evaluated according to the Eagle standard.Results Epilepsy in unilateral was 63.5%(54/85 ),bilateral was 28.2%(24/85 )and unclear was 8.3%(7/85 ).6 months,12 months,18 months and 24 months later after surgery in patients who with unilateral lobe,the efficacy reaching the Eagle class Ⅰ and class Ⅱ standards was 61.1% (33/54),61.1% (33/54),61.1% (33/54),59.1% (29/49 ),respectively.Conclusion PET/CT neural function analysis could find epileptogenic zone which was negative in MRI imaging in patients with refractory epilepsy, is one of the important methods of preoperative localization.
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Objective:To explore the feasibility and safety of CT-guided hookwire localization of small lung nodule in video-as-sisted thoracic surgery. Methods: Preoperative localization of small lung nodule was performed using the CT-guided hookwire tech-nique, followed by video-assisted thoracic surgery in the wedge resection. The next mode of operation depends on the results of frozen biopsy. Results:Preoperative localization with CT-guided hookwire was performed in 34 patients between February 2012 and March 2014. The diameter of lung nodule ranged from 5 mm to 22 mm. CT-guided hookwire localization was successful in all patients, with a median positioning time of 23 min. Puncture needles were detached from two of the total patients during the surgery, and three other pa-tients showed pneumothorax by CT scan after localization. Conclusion:Preoperative hookwire localization of small lung nodule is an accurate and safe approach to improve the rate of wedge resection in video-assisted thoracic surgery.
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PURPOSE: The usual surgical treatment for patients with primary hyperparathyroidism is to remove the diseased parathyroid gland. Despite the high success rate of conventional bilateral exploration of both sides of the neck with identification of all parathyroid glands, there has been considerable recent interest in focal exploration for sporadic primary hyperparathyroidism. The development of preoperative localization methods has been enhancing the effectiveness of various minimally invasive parathyroid surgery. We invented a new surgical method - minimally invasive focused parathyroidectomy (MIFP) and accomplished successful treatment for the patients with primary hyperparathyroidism. The aim of the present paper was to evaluate the effectiveness and safety of this procedure. METHODS: From Jan. 2002 through Sep. 2003, 25 consecutive cases out of 39 patients with primary hyperparathyroidism who were treated by MIFP were enrolled in this study. We analysed retrospectively the success rate, operation time, length of incision, hospital stay, complication rate and influence of preoperative localization methods. RESULTS: There were 21 women and 4 men with a mean age of 54.1 years. All were examined preoperatively with ultrasonography and/or 99mTc-sestamibi scan to localize the diseased parathyroid gland. The mean length of incision was 2.3 cm and mean operation time was 32 min. Twenty-four patients (96.0%) successfully underwent MIFP, with only one case of conversion to conventional approach. CONCLUSION: MIFP is a safe, cost-effective and definite operative method for patients who are appropriately selected by careful preoperative localization studies.
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Female , Humans , Male , Hyperparathyroidism, Primary , Length of Stay , Neck , Parathyroid Glands , Parathyroidectomy , Retrospective Studies , Technetium Tc 99m Sestamibi , UltrasonographyABSTRACT
Objective To evaluate US, CT and 99mTc-MIBI in the localization of hyperfunctioning parathyroid tumors. Methods Among the 47 patients with primary hyperparathyroidism 45 underwent ultrasound, 47 did CT scan and 36 did double phase imagings. Results Forty-six adenomas, 2 adenocarcinomas and 2 hyperplastic glands were removed from 47 patients. The results showed that the sensitivities were 43%,78%,92% for B-utrasound; CT and isotope imaing respectively.The specificities were 96%,97%,100%;and the accuracies were 82%,92%,98%. There was significant difference between 99mTc- MIBI and CT (? 2=6.627,? 2=4.884,P
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Objective To assess the clinical value of low-frequency mini - probe sonography ( LFMPS) in preoperative localization of pancreatic endocrine tumors comparing with other imaging methods. Methods Twenty one cases with suspected pancreatic endocrine tumors were enrolled from June 2000 to June 2002, we compared the diagnostic results of LFMPS, transcutaneous ultrasonography ( US) , helico-computed tomography ( HCT) and magnetic resonance imaging (MRI) with surgical localization and histopathological results by using Fujinon 7. 5 MHz miniature probe and SP-701 ultrasonic system. Results Sixteen pancreatic insulinomas and 1 extra pancreatic VIPoma (vesoactive intestinal polypeptide tumor) were confirmed by surgery and histopathological examination in 17 of the 21 patients, and the rest 4 patients didn't receive surgical procedure because of the negative results in all imaging studies. Among pancreatic lesions, they located on head, body and tail in 9, 3 and 4 cases respectively; the average diameter of all 17 lesions was 2. 02cm. LFMPS correctly localized the tumor in 14 of 17 patients (82. 4% ) while CT in 15 of 17 patients (88. 2% ) , MRI in 12 of 17 patients (70. 6% ) and US in 9 of 17 patients (52. 9% ). Besides, the diagnostic accuracy of LFMPS in detection of small size (