Puncture positioning <i>versus</i> free-of-puncture positioning under three-dimensional navigation in the anatomical segmentectomy for pulmonary nodules: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HU Shuo , WANG Qi , WEI Haixing , PAN Xianglong , HE Zhicheng , XU Jing , ZHU Yining ,  WU Weibing ,  CHEN Liang

Department of Thoracic Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, P.R.China;

Corresponding author：

WU Weibing, Email: wuweibing95@163.com; CHEN Liang, Email: clbright0909@njmu.edu.cn

Keywords：

Ground-glass nodule; three-dimensional reconstruction; preoperative positioning; pulmonary segmentectomy

DOI：

10.7507/1007-4848.202007085

Video：

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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.

Citation： HU Shuo, WANG Qi, WEI Haixing, PAN Xianglong, HE Zhicheng, XU Jing, ZHU Yining, WU Weibing, CHEN Liang. Puncture positioning versus free-of-puncture positioning under three-dimensional navigation in the anatomical segmentectomy for pulmonary nodules: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(10): 1202-1206. doi: 10.7507/1007-4848.202007085 Copy

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2.	王礼同, 汤晓明, 黄华, 等. 电视胸腔镜手术前 CT 引导下亚甲蓝和/或 Hookwire 定位肺磨玻璃结节. 中国医学影像技术, 2019, 35(8): 1220-1223.
3.	赵常坤, 张勇, 王巍炜. 肺磨玻璃结节胸腔镜术前定位的研究进展. 医学综述, 2019, 25(16): 3274-3278.
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5.	叶春林, 喻本桐. 三维 CT 支气管血管成像技术在精准肺段切除中应用的研究进展. 中国医师杂志, 2019, 21(11): 1601-1604.
6.	Wu WB, Xu XF, Wen W, et al. Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy. J Thorac Dis, 2016, 8(Suppl 9): S710-S715.
7.	Thong ISK, Jensen MP, Miró J, et al. The validity of pain intensity measures: What do the NRS, VAS, VRS, and FPS-R measure? Scand J Pain, 2018, 18(1): 99-107.
8.	翟荣, 徐心峰, 王俊, 等. 肺段切除术中改良膨胀萎陷法影响因素研究. 南京医科大学学报(自然科学版), 2018, 38(8): 1136-1139.
9.	郑骢翀, 俞同福, 刘希胜, 等. CT 引导下 Hookwire 及亚甲蓝定位在肺部小结节胸腔镜术前应用. 实用临床医药杂志, 2014, 18(3): 33-35.
10.	张楼乾, 蒋峰, 李明. 无创三维重建在肺部亚厘米结节定位中应用. 南京医科大学学报(自然科学版), 2019, 39(10): 1491-1493.
11.	张斌杰, 张永奎, 乐涵波. 肺结节术中体表定位在胸腔镜手术中的应用研究. 中国癌症杂志, 2017, 27(12): 976-979.
12.	李波, 王宜主, 胡彬, 等. 三维影像重建支气管、血管引导胸腔镜精准肺段、肺亚段切除段间区域结节的策略探讨? 肿瘤预防与治疗, 2019, 32(8): 711-717.
13.	Wu WB, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
14.	张磊, 谢冬, 陈昶. 肺磨玻璃结节术中定位方法的应用进展. 中国胸心血管外科临床杂志, 2018, 25(12): 1080-1084.

1. Zhu Y, Hou D, Lan M, et al. A comparison of ultra-high-resolution CT target scan versus conventional CT target reconstruction in the evaluation of ground-glass-nodule-like lung adenocarcinoma. Quant Imaging Med Surg, 2019, 9(6): 1087-1094.
2. 王礼同, 汤晓明, 黄华, 等. 电视胸腔镜手术前 CT 引导下亚甲蓝和/或 Hookwire 定位肺磨玻璃结节. 中国医学影像技术, 2019, 35(8): 1220-1223.
3. 赵常坤, 张勇, 王巍炜. 肺磨玻璃结节胸腔镜术前定位的研究进展. 医学综述, 2019, 25(16): 3274-3278.
4. Yao F, Wang J, Yao J, et al. Three-dimensional image reconstruction with free open-source OsiriX software in video-assisted thoracoscopic lobectomy and segmentectomy. Int J Surg, 2017, 39: 16-22.
5. 叶春林, 喻本桐. 三维 CT 支气管血管成像技术在精准肺段切除中应用的研究进展. 中国医师杂志, 2019, 21(11): 1601-1604.
6. Wu WB, Xu XF, Wen W, et al. Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy. J Thorac Dis, 2016, 8(Suppl 9): S710-S715.
7. Thong ISK, Jensen MP, Miró J, et al. The validity of pain intensity measures: What do the NRS, VAS, VRS, and FPS-R measure? Scand J Pain, 2018, 18(1): 99-107.
8. 翟荣, 徐心峰, 王俊, 等. 肺段切除术中改良膨胀萎陷法影响因素研究. 南京医科大学学报(自然科学版), 2018, 38(8): 1136-1139.
9. 郑骢翀, 俞同福, 刘希胜, 等. CT 引导下 Hookwire 及亚甲蓝定位在肺部小结节胸腔镜术前应用. 实用临床医药杂志, 2014, 18(3): 33-35.
10. 张楼乾, 蒋峰, 李明. 无创三维重建在肺部亚厘米结节定位中应用. 南京医科大学学报(自然科学版), 2019, 39(10): 1491-1493.
11. 张斌杰, 张永奎, 乐涵波. 肺结节术中体表定位在胸腔镜手术中的应用研究. 中国癌症杂志, 2017, 27(12): 976-979.
12. 李波, 王宜主, 胡彬, 等. 三维影像重建支气管、血管引导胸腔镜精准肺段、肺亚段切除段间区域结节的策略探讨? 肿瘤预防与治疗, 2019, 32(8): 711-717.
13. Wu WB, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
14. 张磊, 谢冬, 陈昶. 肺磨玻璃结节术中定位方法的应用进展. 中国胸心血管外科临床杂志, 2018, 25(12): 1080-1084.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Puncture positioning versus free-of-puncture positioning under three-dimensional navigation in the anatomical segmentectomy for pulmonary nodules: A retrospective cohort study

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