PDF(Pubmed)
Abstract：
BACKGROUND: This study aimed to explore the efficacy of hookwire for computed tomography (CT)-guided pulmonary nodule (PN) localization before video-assisted thoracoscopic surgery (VATS) resection and determine the risk factors for localization-related complications.
METHODS: We enrolled 193 patients who underwent preoperative CT-guided PN hookwire localization. The patients were categorized into groups A (103 patients had no complications) and B (90 patients had complications) according to CT and VATS. Uni- and multivariate logistic regression analyses were used to identify risk factors for localization-related complications. A numerical rating scale was used to evaluate hookwire localization-induced pain.
RESULTS: We successfully performed localization in 173 (89.6%) patients. Pneumothorax was the main complication in 82 patients (42.5%). Patient gender, age, body mass index, tumor diameter, consolidation tumor ratio, pathologic diagnosis, position adjustment during location, lesion location, waiting time for surgery, and pleural adhesions were not significantly different between the two groups. The number of nodules, number of punctures, scapular rest position, and depth of insertion within the lung parenchyma were significant factors for successful localization. Multivariate regression analysis further validated the number of nodules, scapular rest position, and depth of insertion within the lung parenchyma as risk factors for hookwire-localization-related complications. Hookwire localization-induced pain is mainly mild or moderate pre- and postoperatively, and some patients still experience pain 7 days postoperatively.
CONCLUSIONS: Hookwire preoperative PN localization has a high success rate, but some complications remain. Thus, clinicians should be vigilant and look forward to further improvement.
METHODS: We enrolled 193 patients who underwent preoperative CT-guided PN hookwire localization. The patients were categorized into groups A (103 patients had no complications) and B (90 patients had complications) according to CT and VATS. Uni- and multivariate logistic regression analyses were used to identify risk factors for localization-related complications. A numerical rating scale was used to evaluate hookwire localization-induced pain.
RESULTS: We successfully performed localization in 173 (89.6%) patients. Pneumothorax was the main complication in 82 patients (42.5%). Patient gender, age, body mass index, tumor diameter, consolidation tumor ratio, pathologic diagnosis, position adjustment during location, lesion location, waiting time for surgery, and pleural adhesions were not significantly different between the two groups. The number of nodules, number of punctures, scapular rest position, and depth of insertion within the lung parenchyma were significant factors for successful localization. Multivariate regression analysis further validated the number of nodules, scapular rest position, and depth of insertion within the lung parenchyma as risk factors for hookwire-localization-related complications. Hookwire localization-induced pain is mainly mild or moderate pre- and postoperatively, and some patients still experience pain 7 days postoperatively.
CONCLUSIONS: Hookwire preoperative PN localization has a high success rate, but some complications remain. Thus, clinicians should be vigilant and look forward to further improvement.
摘要：
背景：本研究旨在探讨在电视胸腔镜手术（VATS）切除前，在计算机断层扫描（CT）引导下定位肺结节（PN）的有效性，并确定定位相关并发症的危险因素。
方法：我们招募了193例接受术前CT引导下PN钩针定位的患者。根据CT和VATS将患者分为A组（103例患者无并发症）和B组（90例患者有并发症）。使用单因素和多因素逻辑回归分析来确定定位相关并发症的危险因素。使用数字评分量表评估钩针定位引起的疼痛。
结果：我们成功对173例（89.6%）患者进行了定位。气胸是82例(42.5%)患者的主要并发症。患者性别,年龄,身体质量指数,肿瘤直径,实变肿瘤比率，病理诊断,定位过程中的位置调整，病变位置,等待手术的时间,两组胸膜粘连无明显差异。结节的数量,穿刺次数,肩胛骨静止位置，和肺实质内的插入深度是成功定位的重要因素。多元回归分析进一步验证了结节的数量，肩胛骨静止位置，和肺实质内的插入深度是钩丝定位相关并发症的危险因素。Hookwire定位引起的疼痛主要是术前和术后轻度或中度，有些患者术后7天仍有疼痛。
结论：Hookwire术前PN定位成功率高，但是一些并发症仍然存在。因此，临床医生应提高警惕，期待进一步改善。
方法：我们招募了193例接受术前CT引导下PN钩针定位的患者。根据CT和VATS将患者分为A组（103例患者无并发症）和B组（90例患者有并发症）。使用单因素和多因素逻辑回归分析来确定定位相关并发症的危险因素。使用数字评分量表评估钩针定位引起的疼痛。
结果：我们成功对173例（89.6%）患者进行了定位。气胸是82例(42.5%)患者的主要并发症。患者性别,年龄,身体质量指数,肿瘤直径,实变肿瘤比率，病理诊断,定位过程中的位置调整，病变位置,等待手术的时间,两组胸膜粘连无明显差异。结节的数量,穿刺次数,肩胛骨静止位置，和肺实质内的插入深度是成功定位的重要因素。多元回归分析进一步验证了结节的数量，肩胛骨静止位置，和肺实质内的插入深度是钩丝定位相关并发症的危险因素。Hookwire定位引起的疼痛主要是术前和术后轻度或中度，有些患者术后7天仍有疼痛。
结论：Hookwire术前PN定位成功率高，但是一些并发症仍然存在。因此，临床医生应提高警惕，期待进一步改善。
