Medical adhesive vs hookwire for computed tomography-guided preoperative localization and risk factors of major complications
Medical adhesive vs hookwire for computed tomography-guided preoperative localization and risk factors of major complications
复制标题
医用粘合剂与钩线用于计算机断层扫描引导的术前定位和主要并发症的危险因素
DOI：
10.1259/bjr.20201208
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发表时间：
2021-01-01
影响因子：
2.6
通讯作者：
Yang, Lin
中科院分区：
文献类型：
--
作者：
Ye, Weitao;Dong, Chenyu;Yang, Lin
目的：比较医用粘合剂和钩丝作为电视胸腔镜手术（VATS）切除术前CT引导下不可触及肺结节（NPN）定位方法的有效性，并确定定位过程中常见并发症的危险因素。102例患者109个NPN分为A组（医用粘合剂组，66例，72个结节）和B组（钩丝组，36例，37个结节）。比较了患者和结节的特征。Logistic回归分析，以确定并发症的危险因素。结果：定位成功地进行了所有的NPN。对于A组，定位后即刻气胸的发生率低于B组（p = 0.049），定位至手术间隔长于B组（p = 0.011）。两组拔针后出血率无显著差异（β = 0.198）。Hookwire（与医用粘合剂相比）（β = 1.12，p = 0.018），总插入深度（β =-0.41，p = 0.013），胸膜-穿刺针角度=-0.04，p = 0.025）和拔针后出血等级（β =-0.96，p = 0.030）与气胸独立相关，而年龄（β =-0.94，p = 0.018），肿瘤大小（β = 0.29，p = 0.007）及其与胸膜表面的距离（β = 0.14，p = 0.004）与拔针后的高级别出血相关。与钩丝相比，医用粘合剂定位的气胸风险较低，定位至手术间隔更灵活，拔针后出血率相似。Hookwire是一个独立的危险因素气胸后立即localization.Advances的知识：这项研究增加了新的临床证据的疗效，医用粘合剂在术前CT引导NPN定位。
Objective: To compare the efficacy of medical adhesive and hookwire as CT-guided non-palpable pulmonary nodule (NPN) localization methods before video-assisted thoracoscopic surgery (VATS) resection, and determine the risk factors for common complications during localization.Methods: This was a single-center non-randomized retrospective study. 102 consecutive patients with 109 NPNs were divided into Group A (medical adhesive, 66 patients, 72 nodules) and Group B (hookwire, 36 patients, 37 nodules) before VATS. Patient- and nodule-based characteristics were compared. Logistic regression was performed to identify the risk factors for complications.Results: Localization was successfully performed in all the NPNs. For Group A, the rate of pneumothorax immediately after localization was lower (p = 0.049) and the localization-to-surgery interval was longer (p = 0.011) than Group B. There was no significant difference in rates of hemorrhage after needle withdrawal between the two groups (beta = 0.198). Hookwire (vs medical adhesive) (beta = 1.12, p = 0.018), total insertion depth (beta = -0.41, p = 0.013), pleura-needle angle = -0.04, p = 0.025) and grade of hemorrhage after needle withdrawal (beta = -0.96, p = 0.030) were independently associated with pneumo- thorax, while age (beta = -0.94, p = 0.018), tumor size (beta = 0.29, p = 0.007) and its distance from the pleural surface (beta = 0.14, p = 0.004) were associated with higher grade hemorrhage after needle withdrawal.Conclusion: Compared with hookwire, localization with medical adhesive excelled in lower risk of pneumothorax, a more flexible localization-to-surgery interval, and had similar rates of hemorrhage after needle withdrawal. Hookwire is an independent risk factor of pneumothorax immediately after localization.Advances in knowledge: This study added new clinical evidence to the efficacy of medical adhesive in preoperative CT-guided NPN localization.