三维重建联合CT引导下穿刺定位在微创治疗肺磨玻璃结节中的应用

Application of 3D reconstruction combined with CT-guided puncture localization in minimally invasive treatment of pulmonary ground-glass nodules

摘要

目的 比较人工智能(artificial intelligence, AI)辅助肺部CT三维重建联合CT引导下肺结节细针穿刺定位术前管理模式与常规胸腔镜手术术前管理模式在电视辅助胸腔镜手术(video-assisted thoracic surgery, VATS)治疗肺磨玻璃结节(ground-glass nodule, GGN)中的效果。 方法 收集2023年8月至2025年4月吉林大学第一医院胸外二科收治的114例行VATS亚肺叶切除术的GGN患者的临床资料,按照术前是否行AI辅助肺部CT三维重建及CT引导下肺结节穿刺定位,将其分为空白组(n=19)、穿刺组(n=25)、三维重建组(n=16)及联合组(n=54)。空白组术前仅行肺部增强CT检查,穿刺组和三维重建组在此基础上分别于术前行CT引导下肺结节细针穿刺定位或普通CT三维重建,联合组则综合利用了AI辅助肺部CT三维重建联合术前CT引导下肺结节细针穿刺定位。收集并比较以上4组穿刺定位成功率、围手术期相关指标(手术方式、手术时长、术中出血量、术后胸管留置时间、术后引流总量、住院时间、住院费用)等相关临床指标。 结果 联合组与空白组、穿刺组及三维重建组的一般临床资料差异无统计学意义;联合组、穿刺组及三维重建组在麻醉时间、引流总量、引流管留置时间、手术时长、术中出血量以及手术总费用6项术后指标均优于空白组(P<0.05);三维重建组与联合组的住院时间与病灶切除体积小于空白组(P<0.05),而联合组住院时间与病灶切除体积小于穿刺组(P<0.05);穿刺组与联合组术后感染指标降低天数均优于空白组(P<0.05);分析穿刺定位及三维重建组的交互效应结果表明,在麻醉时间、引流总量、引流管留置时间、手术时长、术中出血量及总费用等6项指标中,三维重建与穿刺定位存在交互相应,联合组在定位时间及患者耐受度评分上优于穿刺组。 结论 术前AI辅助CT三维重建联合CT引导下穿刺定位术前管理模式能显著提高VATS亚肺叶切除术围手术期效果,提高患者的生存质量及预后疗效,具有广泛的临床应用前景。

Abstract

Objective To compare the therapeutic outcomes of an artificial intelligence(AI)-assisted lung CT three-dimensional reconstruction combined with CT-guided lung nodule fine-needle aspiration biopsy preoperative management model versus a conventional thoracoscopic surgery preoperative management model in the treatment of ground-glass nodules(GGN)via video-assisted thoracic surgery(VATS). Methods Clinical data were collected from 114 patients with GGN undergoing VATS sublobar resection between August 2023 and April 2025. Patients were categorized into four groups based on whether they underwent AI-assisted 3D reconstruction of pulmonary CT and CT-guided lung nodule localization preoperatively: the control group(n=19), the biopsy group(n=25), the 3D reconstruction group(n=16), and the combinaton group(n=54). The control group underwent only preoperative contrast-enhanced lung CT. The biopsy group and 3D reconstruction group additionally underwent CT-guided lung nodule fine-needle aspiration localization or conventional CT 3D reconstruction, respectively. The combination group utilized both AI-assisted lung CT 3D reconstruction and preoperative CT-guided lung nodule fine-needle aspiration localization. The following clinical indicators were collected and compared across the four groups: needle localization success rate, perioperative parameters(surgical approach, surgical duration, intraoperative blood loss, postoperative chest tube retention time, total postoperative drainage volume, length of hospital stay, and hospitalization costs). Results There were no statistically significant differences in general clinical data between the combination group and the control group, the puncture group, or the 3D reconstruction group. The combination group, puncture group, and 3D reconstruction group all demonstrated superior outcomes compared to the control group in six postoperative indicators: anesthesia duration, total drainage volume, drainage tube retention time, surgical duration, intraoperative blood loss, and total surgical cost(P<0.05). The 3D reconstruction group and combination group had shorter hospital stays and smaller lesion resection volumes than the control group(P<0.05), while the combination group had shorter hospital stays and smaller lesion resection volumes than the puncture group(P<0.05). Both the puncture group and combination group had fewer days of postoperative infection than the control group(P<0.05). There was an interaction between 3D reconstruction and needle localization in six indicators: anesthesia duration, total drainage volume, drainage tube retention time, surgical duration, intraoperative blood loss, and total cost. The combination group demonstrated superiority over the puncture group in localization time and patient tolerance scores. Conclusion The preoperative management model combining AI-assisted CT three-dimensional reconstruction with CT-guided needle localization significantly improves perioperative outcomes in VATS sublobar resection, enhances patient quality of life and prognosis, and holds broad clinical application prospects.

关键词

人工智能 / 三维重建 / 穿刺定位 / 电视辅助胸腔镜手术 / 肺磨玻璃结节

Key words

Artificial intelligence / Three-dimensional reconstruction / Puncture positioning / Video-assisted thoracoscopic surgery / Lung ground-glass nodule

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基金资助

国家自然科学基金青年项目(82002429)