Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Int J Surg. 2019 Nov;71:49-55. doi: 10.1016/j.ijsu.2019.09.001. Epub 2019 Sep 12.
Localizing small pulmonary nodules (SPNs) is a challenge during thoracoscopic resection, but preoperative computed tomography (CT)-guided localization using either cyanoacrylate or hookwire can be helpful. This study compared the safety, efficiency, and operability of the two techniques.
From September 2013 to November 2018, 269 patients (269 SPNs) who underwent preoperative CT-guided SPN localization were enrolled. A propensity-matched analysis, incorporating 13 variables, was performed to control potential selection bias.
All the patients were divided into two groups: CT-guided cyanoacrylate localization group (Group C, n = 149) and CT-guided hookwire localization group (Group H, n = 120). Eighty-six patients were propensity-matched in each group. All SPNs were successfully removed thoracoscopically, and no conversion was required. Localization-related complications in the two groups were similar, including intrapulmonary focal hemorrhage (p = 0.823), pneumothorax (p = 1.000), or hemoptysis (p = 0.121). For pain assessment and management, the cyanoacrylate localization saw a lower pain score (p < 0.001) and less morphine use (p < 0.001). In Group H, the localization took a significantly longer time (p < 0.001). Covering only the patients in Group C, the sub-analysis found that cyanoacrylate localization on the day before surgery did not compromise the accuracy of intraoperative targeting or increase the incidence of complications, compared with the localization on the day of surgery (all p > 0.05).
Compared to hookwire localization, CT-guided cyanoacrylate localization decreased pain and morphine use and allowed flexible surgical schedules, suggestive of its preferability for the resection of SPNs.
在胸腔镜切除术中，定位小的肺结节（SPN）是一个挑战，但术前使用氰基丙烯酸酯或 Hook 线进行 CT 引导定位可能会有所帮助。本研究比较了这两种技术的安全性、效率和可操作性。
从 2013 年 9 月至 2018 年 11 月，对 269 例（269 个 SPN）接受术前 CT 引导 SPN 定位的患者进行了研究。通过纳入 13 个变量的倾向性匹配分析，控制潜在的选择偏倚。
所有患者均分为两组：CT 引导氰基丙烯酸酯定位组（C 组，n=149）和 CT 引导 Hook 线定位组（H 组，n=120）。每组 86 例患者进行了倾向性匹配。所有 SPN 均经胸腔镜成功切除，无需转换。两组的定位相关并发症相似，包括肺内局灶性出血（p=0.823）、气胸（p=1.000）或咯血（p=0.121）。在疼痛评估和管理方面，氰基丙烯酸酯定位的疼痛评分较低（p<0.001），吗啡用量较少（p<0.001）。在 H 组中，定位时间明显较长（p<0.001）。仅对 C 组患者进行亚组分析发现，与手术当天定位相比，手术前一天进行氰基丙烯酸酯定位并不影响术中靶向的准确性或增加并发症的发生率（均 p>0.05）。
与 Hook 线定位相比，CT 引导氰基丙烯酸酯定位可减轻疼痛和吗啡用量，并允许灵活的手术安排，提示其更适合切除 SPN。
