Objective: To explore the accuracy and efficiency of a novel 3D-printed emulation localization model of small pulmonary nodules in lung surgery. Methods: From April 2020 to April 2021, a total of 66 patients were selected in the study, who underwent localization and resection of pulmonary nodules with video-assisted thoracoscopic surgery (VATS) guided by the 3D-printed emulation localization model at Department of Thoracic Surgery, West China Hospital of Sichuan University. There were 13 males and 53 females, aged from 25 to 79 (52.7±11.4) years. Of all patients, 24 (36.4%) had single pulmonary nodule, and 42 (63.6%) had synchronous multiple pulmonary nodules. The chest high-resolution CT image data were utilized for digital reconstruction and 3D printing to make a tailored life-size emulation pulmonary nodules localization model, which was used to navigate real-time intraoperative localization of nodules. Clinical data including operative parameters, localization information, resection types and pathological findings of nodules were analyzed. The pulmonary nodules that doctors planned to resect were categorized into two categories:major nodules and additional nodules, according to their presence of invasion and radiological risk factors. The accuracy of localization and resection efficiency of nodules were evaluated in accordance with the categories of the nodules respectively. Results: On the basis of preoperative evaluation, there were 71 major nodules with median maximal diameter of 0.9 (0.6-1.3) cm, and 77 additional nodules with median maximal diameter of 0.5 (0.4-0.7) cm. All patients underwent VATS surgery, 52 of them (78.8%) were treated with uniportal VATS and 14 (21.2%) with triportal VATS. Among the patients with single nodule, 18 segmentectomies and 6 wedge resections were performed; whereas among the patients with multiple nodules, 5 segmentectomies, 14 wedge resections, and 23 combined pulmonary resections (including 2 cases of lobectomy+segmentectomy, 7 cases of lobectomy+wedge resections, and 14 cases of segmentectomy+wedge resections) were achieved. The median operative time was 93 (45-240) min, and the median resection time for all nodules was 51.4 (6.7-147.0) min. All major nodules were successfully resected and visibly dissected after removal, and all additional nodules were successfully resected with 85.7%(66/77) nodules visibly dissected. The accuracy rate of localization of both types of nodules was 100%. All major nodules were malignant, and the malignancy rate of additional nodules was 21.2%(14/66). Conclusion: This novel 3D-printed emulation localization model of small pulmonary nodules proved to be a non-invasive, accurate and efficient technique. Not only that, it has a unique advantage in localization of synchronous multiple pulmonary nodules.
目的： 研究一种新型的3D打印仿真肺结节无创定位模型用于肺结节切除手术中指引肺小结节定位切除，并分析其准确性和切除效率。 方法： 入选2020年4月至2021年4月四川大学华西医院胸外科采用仿真肺结节定位模型进行胸腔镜手术中肺结节定位，并行肺结节切除手术的66例患者，男13例，女53例，年龄25~79（52.7±11.4）岁。其中单发结节患者24例（36.4%），同时性多发结节42例（63.6%）。使用患者的胸部高分辨CT影像数据进行数字重建，并3D打印制备个体化的1∶1等大仿真肺结节定位模型，用于手术中指引肺结节实时定位。分析手术相关参数、结节定位情况、结节切除情况，以及病理结果等资料。术前计划切除的结节按主要病灶结节和额外结节两种类别分别评估该模型指引定位的准确性和切除效率。 结果： 根据术前评估，66例患者计划切除的主要病灶结节71个，中位最大径0.9 cm（0.6~1.3 cm）；计划切除的额外结节77个，中位最大径0.5 cm（0.4~0.7 cm）。所有患者均行全胸腔镜手术，单孔52例（78.8%），三孔14例（21.2%）；单发结节患者中行肺段切除18例、楔形切除6例；多发结节患者中行肺段切除5例、楔形切除14例，混合术式23例（其中肺叶切除+肺段切除2例、肺叶切除+楔形切除7例、肺段切除+楔形切除14例）。全组中位手术时间93 min（45~240 min），平均每个结节切除中位时间51.4 min（6.7~147.0 min）。主要病灶结节全部成功切除并在手术台上由外科医生在切除标本中全部剖出，额外结节全部成功切除并在切除标本中剖出85.7%（66/77）；模型指引的两种结节定位准确率均为100%。所有主要病灶结节均为恶性，剖出的额外结节恶性比例为21.2%（14/66）。 结论： 本中心设计的基于3D打印的仿真肺结节定位模型技术是一种无创、准确、便捷的肺小结节定位方法，特别在同时性多发肺结节的定位中更具独特优势。.