RÉSUMÉ
Intraoperative positioning nerve injuries are a known complication that can occur during surgical procedures when patients are placed in specific positions on the operating table. The causes of intraoperative positioning nerve injuries are multifactorial and are associated with aspects related to how the patient is positioned during the surgical procedure and the duration for which pressure or tension is applied to nerves. This study was conducted to identify and categorize the various types of intraoperative positioning nerve injuries and to establish prognostic classifications for these injuries. The aim was to address the imperative need for strategies to prevent and manage such injuries effectively. The study involved an extensive review of existing literature, encompassing databases such as PubMed, Web of Science, and Cochrane. Intraoperative positioning nerve injuries can be categorized based on several parameters, including the nature of the injury, the specific nerve or nerve plexus affected, and the severity of the damage incurred. Two major classification systems based on injury extent are Seddon’s and Sunderland’s classifications. Types based on anatomical region can be loosely divided into nerves present in the upper limb, lower limb, head and neck, and thoracic region. The prevention of intraoperative positioning nerve injuries is of paramount importance and hinges on meticulous preoperative planning, the utilization of appropriate positioning techniques, and the diligent monitoring of patients throughout the surgery.
RÉSUMÉ
BACKGROUND@#Computed tomography (CT) three-dimensional reconstruction technology is increasingly used in preoperative planning of patients with ground glass nodule (GGN), but how to accurately locate the nodule and ensure the safe resection edge is still a difficult problem for clinicians. The purpose of this study was to investigate the accuracy, convenience and safety of CT three-dimensional reconstruction combined with intraoperative natural collapse localization in total thoracoscopic segmental pneumonectomy.@*METHODS@#A total of 45 patients with radiographic findings of pulmonary GGN admitted from July 2019 to December 2019 were selected as the study group. All patients received thin-slice CT scan and underwent preoperative three-dimensional reconstruction. After anesthesia, the small thoracic operation opening and the airway of the patients were quickly opened, and the lung was rapidly and naturally collapsed by pressure difference. GGN were positioned according to the natural marker line, and marked with 3-0 prolene line. After specimen removal, the distance between the GGN and the suture mark, the distance between the GGN and the incision margin were measured, and the incision margin was routinely examined. The general clinical data, pathological data and postoperative complications were counted and compared with 45 consecutive patients who were located with hookwire positioning needle in the same period.@*RESULTS@#The average localization time of non-invasive GGN with natural lung collapse during operation was 6.9 min, and the localization accuracy was 90.6%. There were 2 cases of extensive pleural adhesion and 1 case of emphysema. Postoperative pathology was confirmed as lung adenocarcinoma, and the examination of incision margin was negative. No GGNs were scanned again after surgery, and the precise resection rate of lung segment was 100.0%.@*CONCLUSIONS@#CT three-dimensional reconstruction combined with GGN localization of natural lung collapse during operation can shorten the time of searching for GGN during operation and guarantee the safety of the incision margin. It is a more economical and convenient localization method and makes pulmonary segment resection more accurate.