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@#Objective To explore the feasibility and clinical value of free-of-puncture positioning in three-dimension-guided anatomical segmentectomy for ground-glass nodule (GGN) compared with percutaneous positioning. Methods Clinical data of 268 enrolled patients undergoing anatomical pulmonary segmentectomy from October 2018 to June 2019 were retrospectively collected, including 75 males and 193 females with an average age of 56.55±12.10 years. The patients were divided into two groups, including a percutaneous positioning group (n=89) and a free-of-puncture positioning group (n=179). Perioperative data of the two groups were compared. Results The average CT scan times of the percutaneous positioning group was 3.01±0.98 times, and the numerical rating scale (NRS) score of puncture pain was 3.98±1.61 points. Pulmonary compression pneumothorax (≥30%) occurred in 7 (7.87%) patients and intercostal vascular hemorrhage occurred in 8 (8.99%) patients after puncture. Lung nodules were successfully found and removed in both groups. There was no statistically significant difference between the two groups in the location of nodules (P=0.466), operation time (151.83±39.23 min vs. 154.35±33.19 min, P=0.585), margin width (2.07±0.35 cm vs. 1.98±0.28 cm, P=0.750), or the number of excised subsegments (2.83±1.13 vs. 2.73±1.16, P=0.530). Conclusion Anatomical segmentectomy with three-dimensional navigation avoids the adverse consequences of puncture, which has the same clinical efficacy and meets the requirements of oncology compared with percutaneous positioning. The free-of-puncture positioning method can be used for GGN located in the central region of pulmonary segment/subsegment or adjacent to intersegment veins instead of percutaneous positioning.
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Objective To assess the clinical value of preoperative CT-guided microcoil positioning of small solitary pulmonary nodule (SPN) in assisting video-assisted thoracic surgery (VATS) procedure to more quickly and more precisely remove small pulmonary lesions.Methods The clinical data of 90 patients with SPN,who were admitted to authors' hospital during the period from June 2014 to May 2016 to receive VATS,were retrospective analyzed.Preoperative CT-guided microcoil positioning of SPN was employed in 45 patients (group A),while other 45 patients (group B) did not receive preoperative positioning of SPN.The pulmonary lobar wedge resection time,the transfer rate of changing to open chest operation,postoperative hospitalization time,the success rate of microcoil positioning of SPN,complications,etc.of both groups were statistically analyzed.The safety of preoperative CT-guided microcoil positioning of SPN was evaluated,and its benefit-enhancing value for VATS was discussed.Results In group A,the success rate of VATS was 100％ and the success rate of SPN positioning was 95.6％.Postoperative complications included pneumothorax (n=5),pulmonay surface hemorrhage (n=6),and dislodgement of microcoil (n=2).In group B,the success rate of VATS was 84.4％ and the transfer rate of changing to open chest operation was 15.6％.In group A,the manipulation time of VATS was (17.7±2.8) min,the postoperative hospitalization time was (6.2±1.7) days,and the transfer rate of changing to open chest operation was 0％,which were strikingly lower than those in group B;the differences between the two groups were statistically significant (P＜0.05).Conclusion Preoperative CT-guided microcoil positioning of small SPN can assist VATS procedure to remove small pulmonary lesions more quickly and more precisely,it can effectively reduce the transfer rate of changing to open chest operation,shorten the manipulation time of VATS as well as the postoperative hospitalization time.
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Objective To investigate the clinical value of ultrasonic positioning before sterilization in surgical treatment of thyroid disease. Methods A total of 80 patients with multiple thyroid lesions received ultrasonic positioning before sterilization for surgical treatment. We observed the number, location (in the upper and/or lower pole), and its distance to the posterior envelope. We also recorded the resection rate, the exploration time, and the incidences of complications(hoarseness and hypocalcaemia). Another 80 patients who did not receive ultrasonic positioning served as the controls. Results The lesions were rapidly identified in the ultrasonic positioning group, with the resection rate being 93.75% (75/80) and the exploration time being significantly shorter for patients with multiple lesions; moreover, ultrasonic positioning mades it unnecessary to expose the recurrent laryngeal nerve when the nodule was more than 5 mm away from the posterior envelope, so only 70.00% (56/80) of the patients exposed their recurrent laryngeal nerve. In control group, follow-up was the only available solution for the non-superficial nodules less than 5 mm, with the resection rate being only 76.25% (61/80); the only way to deal with dubious lesions was subtotal thyroidectomy, with the exposure rate of the recurrent laryngeal nerve being 92.50% (74/80). Significant differences were found between ultrasonic and non-ultrasonic groups in terms of resection rate and the exposure rate of the recurrent laryngeal nerve (P<0.01). One patient suffered from a slight deep voice after the operation due to the position of the cancerous node (close to the entrance to the throat of the recurrent laryngeal nerve), and no other patients suffered from severe postoperative complications. Conclusion Post-anesthesia ultrasonic positioning before sterilization can help to understand the numbers of thyroid lesions and their 3-dimensional distribution, and shorten the exploration time. So it is a technique that can not only improve the surgical accuracy and resection rate, but also reduce the difficulty of the surgery.