Abstract: Objective To investigate the application of CT-guided percutaneous localization with the aid of accurate puncture sleeve in the preoperative localization of peripheral pulmonary micronodules. Method From September 2016 to February 2019, patients who had pulmonary nodules found by low-dose CT and indicated for preoperative CT localization were enrolled and randomly assigned to two groups: precision puncture kit combined traditional thoracic puncture needle group （experimental group） and traditional thoracic puncture needle group （control group）. The success rate of the first puncture of small nodules, the incidence of pneumothorax and the success rate of preoperative localization were compared between the two groups. Result The success rate of the first injection in the experimental group were significantly higher than the control group （78.73% vs. 48.94%,P=0.002）. The incidence of asymptomatic pneumothorax in the experimental group were significantly lower than the control group （0% vs. 8.51%, P=0.041）. The success rate of localization of pulmonary nodules before operation in the experimental group were significantly higher than the control group （95.74% vs. 93.62%, P=0.646）. Conclusion Accurate puncture needle combined with traditional thoracic puncture needle assisted CT localization can increase the success rate of puncture positioning for the first time and reduce the incidence of pneumothorax, which is worthy of clinical application.