Treatment method for intractable pneumothorax under guidance of CT (Computed Tomography)

Abstract

The invention discloses a treatment method for intractable pneumothorax under the guidance of CT (Computed Tomography), which comprises the following steps of: 1, carrying out clinical examination before an operation on an intractable pneumothorax patient needing to be treated through clinical consultation, carrying out consultation judgment according to the clinical examination, and signing an informed consent before the operation; the position and the form of the broncho pleural fistulae are accurately displayed through CT three-dimensional reconstruction, the position of the fistulae is accurately punctured through a PTCB needle under local anesthesia, the purpose of plugging the fistulae is achieved by selecting proper plugging materials such as a medical adhesive / iodized oil mixture, a spring ring and gelatin sponge, and the clinical applicability of the intractable pneumothorax plugging operation under CT guidance is high; required CT and plugging materials are conventionally available in primary hospitals; the device is simple in structure, convenient to operate, accurate in plugging and capable of being carried out only under local anesthesia, most patients can tolerate multiple operations, minimally invasive, safe, efficient and instant in effect, has very important diagnosis and treatment significance on treatment of most refractory pneumothorax, and is worthy of clinical application and popularization.

Description

Technical Field

[0001] This invention relates to the field of CT-guided pneumothorax treatment technology, specifically a CT-guided treatment method for refractory pneumothorax. Background Technology

[0002] Pneumothorax refers to the entry of air into the pleural cavity, causing a prolonged state of air accumulation within the pleural cavity. This compression can lead to irreversible lung expansion and impaired lung function. Clinically, it is classified into three types: closed, tension, and open. According to etiology, it can be divided into spontaneous pneumothorax, iatrogenic pneumothorax, and traumatic pneumothorax. Refractory pneumothorax, also known as "intractable pneumothorax" or "persistent pleural leakage," is defined as the presence of active air leakage after 7 days of continuous intercostal drainage for various types of pneumothorax. The difficulty in treating refractory pneumothorax lies in its prolonged course, which severely affects the patient's quality of life. Sometimes, complications such as secondary infections and respiratory failure may occur, even endangering life. Patients often have numerous underlying diseases, cannot tolerate surgical treatment, have limited treatment options, unpredictable outcomes, and are prone to recurrence, requiring multiple treatments.

[0003] Currently, treatments for refractory pneumothorax both domestically and internationally include conservative treatments such as bed rest, oxygen therapy, and treatment of the underlying disease; aspiration, closed drainage, and negative pressure suction; induction of chemical drugs such as minocycline and doxycycline through a chest tube to induce aseptic pleural inflammation; closure of the pleural space (medical pleural sclerotherapy); selective bronchial occlusion (bronchoscopy); and surgical procedures such as thoracoscopic bullectomy, pleurodesis, and bronchopleural fistula repair. Surgical treatments for refractory pneumothorax are minimally invasive procedures assisted by thoracoscopic surgery, which are effective for some patients who can tolerate surgery, such as those who have spontaneously ruptured bullae. However, for some patients who cannot tolerate surgery... For patients with these conditions, surgical treatment is still not feasible and is quite expensive, requiring general anesthesia, which is often not feasible in primary hospitals. Endoscopic selective bronchial occlusion involves the selective and reversible occlusion of the responsible draining bronchus leading to a pleural fistula (or rupture site) to block or significantly reduce air leakage, thereby allowing the affected lung to re-expand and accelerating fistula healing. However, this technique involves complex procedures for locating the responsible draining bronchus, and intravenous sedation and analgesia are generally recommended, which some patients cannot tolerate. Furthermore, the incidence of obstructive pneumonia is high, and occluders such as one-way valves, bronchial plugs, and tamponade balloons may shift. Primary hospitals face difficulties in performing this procedure, specifically in the following ways: (1) The location of the bronchopleural fistula is complex and needs to be performed under general anesthesia. The patient needs to tolerate the surgery. Due to limitations in hardware equipment, it is generally difficult for primary hospitals to carry out the procedure. (2) When performing surgery for refractory pneumothorax, the location of the bronchopleural fistula is complex and precise percutaneous puncture cannot be performed, which reduces the safety of the surgery. (3) The location of the bronchopleural fistula is complex, the sealing material may shift, and it is difficult to inject. Summary of the Invention

[0004] The purpose of this invention is to provide a treatment method for refractory pneumothorax under CT guidance, in order to solve the problems mentioned in the background art regarding the current treatment of pneumothorax: (1) The location of the bronchopleural fistula is complicated, requiring intravenous general anesthesia, which requires the patient to tolerate the surgery. Due to limitations in hardware equipment, it is generally difficult to carry out the procedure in primary hospitals; (2) During the surgery for refractory pneumothorax, the location of the bronchopleural fistula is complicated, making it impossible to perform precise percutaneous puncture, thereby reducing the safety of the surgery; (3) The location of the bronchopleural fistula is complicated, and the sealing material may shift and is difficult to inject.

[0005] To achieve the above objectives, the present invention provides the following technical solution: a CT-guided treatment method for refractory pneumothorax, comprising the following steps: Step 1: For patients with refractory pneumothorax who require treatment after clinical consultation, a clinical examination is conducted before surgery, and a consultation is held based on the clinical examination to make a judgment. Informed consent is signed before surgery. Step 2: Complete the chest CT plain scan and 3D reconstruction, and accurately display the location and morphology of the bronchopleural fistula through CT 3D post-processing reconstruction technology; Step 3: Preoperative planning for minimally invasive intervention: Based on the location of the patient's fistula, select an appropriate puncture point and puncture path, avoiding important organs and tissues / blood vessels; Step 4: Select a suitable position for CT-guided percutaneous puncture to the fistula. It is recommended to use the body membrane fixation position to ensure patient comfort and consistency of operation during the operation. Step 5: After puncturing to the fistula opening, select a suitable sealing agent and seal it completely; Step Six: After the closure is completed, instruct the patient to turn over. This is especially suitable for patients with refractory pneumothorax caused by ruptured bullae, as it allows the closure agent to be applied evenly, resulting in better clinical efficacy. Step 7: After the treatment is completed, it is recommended not to perform closed thoracic aspiration immediately to avoid the imbalance of internal and external pressure, which may cause the closure to fail. Step 8: Follow up every 2 weeks during the first month after surgery. Follow-up includes monitoring the treatment effect, the presence of pneumothorax and related complications. Follow up every 4 weeks for the next 6 months after surgery until the condition is cured and there is no recurrence.

[0006] Preferably, the CT three-dimensional post-processing reconstruction technology in step two includes multiplanar reconstruction (MPR), minimum density projection (MinMIP), and curved surface reconstruction (CPR).

[0007] Preferably, the clinical examination in step one includes routine preoperative examinations such as complete blood count, coagulation, and electrocardiogram.

[0008] Preferably, the electrocardiogram captures electrical signals emitted by the sinoatrial node through electrodes connected to the limbs and chest, forming key waveforms such as the P wave, QRS complex, and T wave. Abnormal P waves indicate atrial hypertrophy, changes in the QRS complex reflect ventricular problems, and flattened or inverted T waves may indicate myocardial ischemia.

[0009] Preferably, the calculation formula for the CT three-dimensional post-processing reconstruction technology in step two is... P ( wu , wv )= F ( wx , wy , wz for( wx , wy , wz )∈Π( θ ).

[0010] Preferably, in the calculation formula of the CT three-dimensional post-processing reconstruction technology P ( wu , wv ) is the projection p(u,v) p ( u , v Two-dimensional Fourier transform (u,v) u , v (for detector coordinates) F ( wx , wy , wz f(x,y,z) is the distribution of the object's attenuation coefficient. f ( x , y , z The three-dimensional Fourier transform of Π(θ) is given by Π(θ), which represents a plane parallel to the detector plane and passing through the origin, and θ is the projection angle.

[0011] Preferably, in step four, the CT-guided percutaneous puncture to the fistula involves the doctor using real-time image navigation via computed tomography to accurately locate the fistula and inserting a catheter or puncture needle through a tiny skin incision to reach the target area, providing a foundation for subsequent occlusion treatment.

[0012] Preferably, the procedure is typically performed under local anesthesia, with the physician dynamically monitoring and adjusting the puncture path via CT scan to ensure accurate avoidance of important tissue structures.

[0013] Preferably, the sealing agent in step five is a mixture of medical tissue adhesive / iodized oil, a spring coil, or a gelatin sponge.

[0014] Compared with the prior art, the beneficial effects of the present invention are: 1. This invention uses CT three-dimensional reconstruction, namely multiplanar reconstruction MPR / minimum density projection MinMIP / curved surface reconstruction CPR, to accurately display the location and morphology of the bronchopleural fistula. Under local anesthesia, the fistula can be precisely punctured with a PTCB needle, which allows most patients to tolerate multiple surgeries and can accurately identify the bronchopleural fistula in refractory pneumothorax.

[0015] 2. This invention, through CT-guided closure of refractory pneumothorax, has strong clinical applicability. The required CT scanner and closure materials are routinely available in primary hospitals. It allows for precise closure, requires only local anesthesia, and most patients can tolerate multiple surgeries. It is minimally invasive, safe, efficient, and provides immediate results. It has significant diagnostic and therapeutic value for the treatment of most refractory pneumothoraxes and is worthy of clinical application and promotion.

[0016] 3. This invention involves precisely puncturing the fistula site with a PTCB needle under local anesthesia. After the surgery, a suitable sealing agent is selected according to the size of the surgical opening. After the wound is fully sealed, the surgery is completed. Suitable sealing materials such as medical adhesive / iodized oil mixture, spring coils, and gelatin sponges are selected to achieve the purpose of sealing the fistula. Attached Figure Description

[0017] Figure 1 This is a schematic diagram of the treatment process of the present invention; Figure 2 This is a schematic diagram of iatrogenic refractory pneumothorax according to the present invention; Figure 3 This is a schematic diagram of the percutaneous puncture to the fistula opening under CT guidance to release the sealing agent according to the present invention; Figure 4 This is a schematic diagram of a follow-up examination one month after CT-guided closure of refractory pneumothorax according to the present invention. Detailed Implementation

[0018] The technical solutions of the embodiments of the present invention will be clearly and completely described below with reference to the accompanying drawings. Obviously, the described embodiments are only some embodiments of the present invention, and not all embodiments. Based on the embodiments of the present invention, all other embodiments obtained by those skilled in the art without creative effort are within the scope of protection of the present invention.

[0019] Example 1: Please see Figures 1 - 4A CT-guided treatment method for refractory pneumothorax, comprising the following steps: Step 1: For patients with refractory pneumothorax who require treatment after clinical consultation, a clinical examination is conducted before surgery. Based on the clinical examination, a consultation is held to make a judgment. Informed consent is signed before surgery. The doctor conducts the following preoperative examinations for patients with refractory pneumothorax: After clinical consultation, routine preoperative examinations such as blood routine, coagulation, and electrocardiogram are performed. Based on the clinical examination, a consultation is held to make a judgment. Informed consent is signed before surgery is confirmed. Step 2: Complete the chest CT plain scan and 3D reconstruction. The location and morphology of the bronchopleural fistula are accurately displayed through CT 3D post-processing reconstruction technology. Patients with refractory pneumothorax are included in the detection equipment. The chest CT plain scan and 3D reconstruction are completed, and then the condition of patients with refractory pneumothorax is analyzed through CT 3D to determine and display the location and morphology of the bronchopleural fistula. Step 3: Minimally invasive interventional preoperative planning: Based on the location of the patient's fistula, select an appropriate puncture point and puncture path, avoiding important organs and tissues / blood vessels. The doctor will formulate a plan based on the location and shape of the patient's bronchopleural fistula, and select an appropriate puncture point and puncture path based on the location of the patient's fistula, avoiding important organs and tissues / blood vessels. Step 4: Select a suitable position for CT-guided percutaneous puncture to the fistula opening. It is recommended to use the body membrane fixation position to ensure patient comfort and consistency of operation during the operation. When performing surgery on the patient, select a suitable position for CT-guided percutaneous puncture to the fistula opening. It is recommended to use the body membrane fixation position to prevent positional movement during the operation from affecting the normal progress of the operation and to ensure patient comfort and consistency of operation during the operation. Step 5: After puncturing to the fistula, select an appropriate sealing agent and seal it completely. After the operation, select an appropriate sealing agent according to the size of the surgical opening and seal the wound completely to complete the operation. Step Six: After the closure is completed, instruct the patient to turn over. This is especially suitable for patients with refractory pneumothorax caused by ruptured bullae, as it allows the closure agent to be applied evenly, resulting in better clinical efficacy. Step 7: After the treatment is completed, it is recommended not to perform closed thoracic aspiration immediately to avoid the imbalance of internal and external pressure, which may cause the closure to fail. Step 8: Follow up every 2 weeks during the first month after surgery. Follow-up includes monitoring the treatment effect, the presence of pneumothorax and related complications. Follow up every 4 weeks for the next 6 months after surgery until the condition is cured and there is no recurrence.

[0020] In this embodiment: the CT three-dimensional post-processing reconstruction technology in step two includes multiplanar reconstruction MPR, minimum density projection MinMIP and curved surface reconstruction CPR.

[0021] In this embodiment: the clinical examination in step one includes routine preoperative examinations such as blood routine, coagulation, and electrocardiogram.

[0022] In this embodiment: the electrocardiogram captures the electrical signals emitted by the sinoatrial node through electrodes connected to the limbs and chest, forming key waveforms such as the P wave, QRS complex, and T wave. Abnormal P wave indicates atrial hypertrophy, changes in the QRS complex reflect ventricular problems, and flattened or inverted T wave may indicate myocardial ischemia.

[0023] In this embodiment: the calculation formula for CT three-dimensional post-processing reconstruction technology in step two. P ( wu , wv )= F ( wx , wy , wz for( wx , wy , wz )∈Π( θ ).

[0024] In this embodiment: the calculation formula for CT three-dimensional post-processing reconstruction technology... P ( wu , wv ) is the projection p(u,v) p ( u , v Two-dimensional Fourier transform (u,v) u , v (for detector coordinates) F ( wx , wy , wz f(x,y,z) is the distribution of the object's attenuation coefficient. f ( x , y , z The three-dimensional Fourier transform of Π(θ) is given by Π(θ), which represents a plane parallel to the detector plane and passing through the origin, and θ is the projection angle.

[0025] In this embodiment: Step four involves CT-guided percutaneous puncture to the fistula. The procedure involves the doctor using real-time image navigation via computed tomography to accurately locate the fistula and inserting a catheter or puncture needle through a tiny skin incision to reach the target area, providing a foundation for subsequent occlusion treatment.

[0026] In this embodiment: the procedure is usually performed under local anesthesia, and the doctor adjusts the puncture path through dynamic monitoring via CT to ensure accurate avoidance of important tissue structures.

[0027] In this embodiment: the sealing agent in step five is a mixture of medical tissue glue / iodized oil, a spring coil, and a gelatin sponge.

[0028] In summary, this technique accurately displays the location and morphology of the bronchopleural fistula through 3D CT reconstruction. Under local anesthesia, a PTCB needle is precisely punctured to the fistula location, and appropriate sealing materials such as medical adhesive / iodized oil mixture, coils, or gelatin sponge are selected to seal the fistula. Moreover, CT-guided closure of refractory pneumothorax is clinically applicable, and the required CT scanner and sealing materials are routinely available in primary hospitals. Precise closure is performed under local anesthesia, and most patients can tolerate multiple surgeries. It is minimally invasive, safe, efficient, and provides immediate results. It has significant diagnostic and therapeutic value for the treatment of most refractory pneumothoraxes and is worthy of clinical application and promotion.

[0029] It should be noted that, in this document, relational terms such as "first" and "second" are used only to distinguish one entity or operation from another, and do not necessarily require or imply any such actual relationship or order between these entities or operations. Furthermore, the terms "comprising," "including," or any other variations thereof are intended to cover non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements includes not only those elements but also other elements not expressly listed, or elements inherent to such process, method, article, or apparatus.

[0030] Although embodiments of the invention have been shown and described, it will be understood by those skilled in the art that various changes, modifications, substitutions and alterations can be made to these embodiments without departing from the principles and spirit of the invention, the scope of which is defined by the appended claims and their equivalents.

Claims

1. A CT-guided treatment method for refractory pneumothorax, characterized in that: The treatment method includes the following steps: Step 1: For patients with refractory pneumothorax who require treatment after clinical consultation, a clinical examination is conducted before surgery, and a consultation is held based on the clinical examination to make a judgment. Informed consent is signed before surgery. Step 2: Complete the chest CT plain scan and 3D reconstruction, and accurately display the location and morphology of the bronchopleural fistula through CT 3D post-processing reconstruction technology; Step 3: Preoperative planning for minimally invasive intervention: Based on the location of the patient's fistula, select an appropriate puncture point and puncture path, avoiding important organs and tissues / blood vessels; Step 4: Select a suitable position for CT-guided percutaneous puncture to the fistula. It is recommended to use the body membrane fixation position to ensure patient comfort and consistency of operation during the operation. Step 5: After puncturing to the fistula opening, select a suitable sealing agent and seal it completely; Step Six: After the closure is completed, instruct the patient to turn over. This is especially suitable for patients with refractory pneumothorax caused by ruptured bullae, as it allows the closure agent to be applied evenly, resulting in better clinical efficacy. Step 7: After the treatment is completed, it is recommended not to perform closed thoracic aspiration immediately to avoid the imbalance of internal and external pressure, which may cause the closure to fail. Step 8: Follow up every 2 weeks during the first month after surgery. Follow-up includes monitoring the treatment effect, the presence of pneumothorax and related complications. Follow up every 4 weeks for the next 6 months after surgery until the condition is cured and there is no recurrence.

2. The treatment method for refractory pneumothorax under CT guidance according to claim 1, characterized in that: The CT three-dimensional post-processing reconstruction techniques in step two include multiplanar reconstruction (MPR), minimum density projection (MinMIP), and curved surface reconstruction (CPR).

3. The treatment method for refractory pneumothorax under CT guidance according to claim 1, characterized in that: The clinical examinations in step one include routine preoperative examinations such as blood routine tests, coagulation tests, and electrocardiograms.

4. The treatment method for refractory pneumothorax under CT guidance according to claim 3, characterized in that: The electrocardiogram (ECG) captures electrical signals emitted by the sinoatrial node through electrodes connected to the limbs and chest, forming key waveforms such as the P wave, QRS complex, and T wave. Abnormal P waves indicate atrial hypertrophy, changes in the QRS complex reflect ventricular problems, and flattened or inverted T waves may indicate myocardial ischemia.

5. The treatment method for refractory pneumothorax under CT guidance according to claim 1, characterized in that: The calculation formula for CT three-dimensional post-processing reconstruction technology in step two P ( wu , wv )= F ( wx , wy , wz for( wx , wy , wz )∈Π( θ ).

6. The treatment method for refractory pneumothorax under CT guidance according to claim 5, characterized in that: The calculation formula of the CT three-dimensional post-processing reconstruction technology P ( wu , wv ) is the projection p(u,v) p ( u , v Two-dimensional Fourier transform (u,v) u , v (for detector coordinates) F ( wx , wy , wz f(x,y,z) is the distribution of the object's attenuation coefficient. f ( x , y , z The three-dimensional Fourier transform of Π(θ) is given by Π(θ), which represents a plane parallel to the detector plane and passing through the origin, and θ is the projection angle.

7. The treatment method for refractory pneumothorax under CT guidance according to claim 1, characterized in that: In step four, CT-guided percutaneous puncture to the fistula involves the doctor using real-time image navigation via computed tomography to accurately locate the fistula and inserting a catheter or puncture needle through a tiny skin incision to reach the target area, providing a foundation for subsequent closure treatment.

8. A treatment method for refractory pneumothorax under CT guidance according to claim 7, characterized in that: This procedure is usually performed under local anesthesia, and the doctor uses CT scans to dynamically monitor and adjust the puncture path to ensure that important tissue structures are accurately avoided.

9. The treatment method for refractory pneumothorax under CT guidance according to claim 1, characterized in that: The sealing agent in step five is a mixture of medical tissue glue / iodized oil, spring coils, and gelatin sponge.

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