ObjectiveTo explore the influencing factors for Hook-wire precise positioning under CT guidance, determine the best positioning management strategy, and develop Nomogram prediction model. Methods Patients who underwent CT-guided Hook-wire puncture positioning in our hospital from July 2018 to November 2022 were selected. They were randomly divided into a training set and a validation set with a ratio of 7 : 3. Clinical data of the patients were analyzed, and the logistic analysis was used to screen out the risk factors that affected CT-guided Hook-wire precise positioning for the training set. The Nomogram prediction model was constructed according to the risk factors, and the goodness of fit test and clinical decision curve analysis were performed. ResultsA total of 199 patients with CT-guided Hook-wire puncture were included in this study, including 72 males and 127 females, aged 25-83 years. There were 139 patients in the training set and 60 patients in the validation set. In the training set, 70 patients were accurately located, with an incidence of 50.36%. Logistic regression analysis showed that height [OR=3.46, 95%CI (1.44, 8.35), P=0.006], locating needle perpendicular to the horizontal plane [OR=3.40, 95%CI (1.37, 8.43), P=0.008], locating needle perpendicular to the tangent line of skin surface [OR=6.01, 95%CI (2.38, 15.20), P＜0.001], CT scanning times [OR=3.03, 95%CI (1.25, 7.33), P=0.014], occlusion [OR=10.56, 95%CI (1.98, 56.48), P=0.006] were independent risk factors for CT-guided Hook-wire precise localization. The verification results of the Nomogram prediction model based on these independent risk factors showed that the area under the receiver operating characteristic curve (AUC) was 0.843 [95%CI (0.776, 0.910)], and the predicted value of the correction curve was basically consistent with the measured value. The AUC of the model in the validation set was 0.854 [95%CI (0.759, 0.950)]. The decision curves showed that when the threshold probability was within the range of 8%-85% in the training set and 18%-99% in the validation set, there was a high net benefit value. Conclusion Height, the locating needle perpendicular to the horizontal plane, the locating needle perpendicular to the tangent line of skin surface, number of CT scans, and occlusion are independent risk factors for CT-guided Hook-wire accurate localization. The Nomogram model established based on the above risk factors can accurately assess and quantify the risk of CT-guided Hook-wire accurate localization.
Objective To examine the application effectiveness of double 8F ultra-fine pigtail tube drainage versus a single 28F thick chest tube in single-incision thoracoscopic lobectomy/Segmentectomy. Methods Clinical data of patients who underwent single-port video-assisted thoracoscopic lung segment/lobe resection surgeries within our medical group from January 2020 to August 2023 were retrospectively analyzed. They were categorized into two groups based on postoperative drainage methods: a dual 8F ultrafine pigtail tube drainage and a single 28F large-bore chest tube drainage. Comparative analysis was performed on perioperative data for the two groups of patients. Results The group with dual 8F ultrafine pigtail tubes comprised 68 patients, with 41 females and 27 males, and an average age of 54.72±13.34 years, while the group with a single 28F large-bore chest tube comprised 80 patients, with 40 females and 40 males, and an average age of 57.60±11.04 years. There were statistical differences between the two groups in terms of postoperative drainage volume on day 1, day 2, and day 3, total postoperative drainage volume, postoperative tube placement time, postoperative pain score at 48 hours, maximum postoperative pain score, postoperative hospital stay, postoperative complications related to drainage tubes, and emergency use of painkillers after surgery. Conclusion After single-port thoracoscopic lung lobe/segmentectomy, the application of dual ultrafine 8F pigtail drainage can lead to a reduction in postoperative drainage volume. This approach also shortens the duration of postoperative drainage tube placement and hospital stay, thereby decreasing postoperative pain and the frequency of emergency analgesic injections. Moreover, it lowers the incidence of drainage tube-related complications. In alignment with current enhanced recovery after surgery principles, this approach is advantageous for patient postoperative recovery and holds clinical significance for broader adoption.