Objective To investigate the safety and efficacy of completely thoracoscopic lobectomy and the indications of this procedure. Methods Between Sep. 2006 and Jun. 2008, 100 consecutive patients（46 men，54 women, median age60.1±12.5 years，range from 18 to 82 years) underwent completely thoracoscopic lobectomy. All candidates were either peripheral pulmonary nodules suspected of lung cancer (85 pts.) or benign lesions (15 pts.) localized within single lobe who needed to receive lobectomy. The lobectomy was completed through three tiny incisions in the intercostal space. Anatomic lobectomies were carried out in all cases and systemic lymph node dissection was performed in malignancies. This group consisted of lobectomies of right upper lobe (n=25), right middle lobe (n=14), right lower lobe (n=22), left upper lobe (n=18), and left lower lobe (n=21). Results All procedures were successfully completed except for 3 conversions to thoracotomy. Postoperative diagnosis were primary lung cancer (n=81), lymphoma (n=1), metastasis of clear cell carcinoma from kidney (n=1), and, benign lesions (n=17). Five patients had mild complications in which two had atelectasis, one needed temperately echanical ventilation, one had pneumonia and one had chylothorax. All were treated conservatively without reoperation. No operative mortality or serious complications occurred in this group. The operative duration was 186.4±52.9min (range from 60 to 300 minutes). The blood loss was 233.9±275.9ml（range from 50 to 750ml）, and only one case needed blood transfusion. Chest drainage time was 7.1±3.0 days. Postoperative hospital stay was 9.5±3.2 days. Followedup time was for 1 to 27 months, metastasis happened in two patients with primary lung cancer 15 and 3 months separately after operation. Conclusion The completely thoracoscopic lobectomy is a safe and feasible surgical procedure with minimal invasiveness. The advocated indications include selected peripheral typed early stage lung cancer and benign pulmonary lesions which need lobectomy.
Abstract： Objective To introduce the new procedure of endobronchial ultrasoundguided transbronchial needle aspiration (EBUSTBNA) for staging lung cancer and diagnosing thoracic diseases, in order to determine its value in the evaluation of thoracic diseases. Methods We retrospectively reviewed the data of all patients examined with EBUSTBNA our institution between September 2009 and May 2010. Among the patients, there were 75 males and 31 females with an average age of 62.3 years old. Based on their primary indication, we divided all the 106 patients into three categories. (1) There were 76 patients with known or bly suspected lung cancer. Enlarged mediastinal lymph nodes on radiographic examination of the chest (≥1.0 cm) were detected in all the patients. (2) There were 22 patients with enlarged mediastinal lymph nodes or mediastinal masses of unknown origin. (3) There were 8 patients with pulmonary mass located close to the central airways. Results (1) 76 patients underwent EBUSTBNA for known or bly suspected lung cancer. Among them, 58 patients were confirmed to have mediastinal lymph nodes metastasis on EBUSTBNA. Sixteen in the 18 patients with negative EBUSTBNA underwent thoracoscopy or thoracotomy for pulmonary resection and mediastinal lymph node dissection. Postoperative pathology confirmed that 12 patients did not have metastatic nodes, 2 patients had metastatic nodes and 2 other patients had benign lesions within the lung. The diagnostic sensitivity, specificity and accuracy of EBUSTBNA for the mediastinal staging of lung cancer were 96.66%(58/60), 100.00%(12/12) and 97.22%(70/72), respectively. (2) 22 patients underwent EBUSTBNA for the evaluation of mediastinal adenopathy or mass in the absence of any identifiable pulmonary lesion. Among them, 7 had malignancy, 13 had benign diseases on EBUSTBNA and the sensitivity of EBUSTBNA in distinguishing malignant mediastinal diseases was 87.50% (7/8). (3) 8 patients with pulmonary mass located close to the central airways were accessed by EBUSTBNA. Definite diagnosis was achieved in 7 patients, and lung cancer was detected in 6 patients. The sensitivity and the diagnostic accuracy of EBUSTBNA for the diagnosis of unknown pulmonary mass was 85.71%(6/7) and 87.50%(7/8), respectively. All the procedures were uneventful, and there were no complications. Conclusion EBUSTBNA is a highly effective and safe procedure. We believe that EBUSTBNA should be used routinely in the diagnosis and staging of thoracic diseases.
ObjectiveTo observe the effect of Mongolian medicine fumigation combined with sciatic nerve and rectal probe electrical stimulation on muscle spasticity of spinal cord injury.MethodsBetween January 2012 and January 2018, a total of 65 patients with muscle spasticity after spinal cord injury were randomly divided into two group: the observation group (32 cases) and the control group (33 cases). The patients in the observation group were treated with Mongolian medicine (Wu Wei Gan Lu-Decoction) fumigation combined with sciatic nerve and rectal probe electrical stimulation, while the patients in the control group were treated with medicine, physical therapy, and exercise therapy. Both two groups were treated for 8 weeks. The patients were scored with Ashworth Score, American Spinal Injury Association (ASIA) score, and Barthel Index before and after treatment.ResultsThe pre-treatment ASIA scores (light touch sensation, pain sensation, and muscle strength) and Barthel Index of the two groups were not statistically significant (P>0.05). The post-treatment ASIA scores and Barthel Index of both groups performed significantly better than the pre-treatment levels (P<0.05). The post-treatment ASIA muscle strength item was 58.55±10.83 in the observation group and 50.69±11.32 in the control group (P<0.05). The post-treatment Barthel Index was 74.22±11.53 in the observation group and 68.46±9.92 in the control group (P<0.05). The effective rate in the observation group was significantly better than that in the control group (84.4% vs. 60.6%, P<0.05). Conclusion Mongolian medicine fumigation combined with sciatic nerve and rectal probe electric stimulation could improve the muscle spasticity of spinal cord injury and patients’ ability of daily life effectively.
ObjectiveTo observe the effectiveness of core endurance isokinetic strength training on subacromial impingement syndrome (SAIS) rehabilitation.MethodsSAIS patients were selected from the Rehabilitation Department, Second Affiliated Hospital of Inner Mongolia Medical University from January 2018 to June 2019. The patients were randomly divided into observed group and control group by random number table method. The patients in control group were treated by keritherapy, cold, standard physiotherapy (PT) and exercise. At the same time, the patients in observed group were treated by core endurance isokinetic strength training combined with keritherapy, cold and standard PT. Both two groups were treated for 8 weeks. The patients were scored with visual analogue scale (VAS), Shoulder Pain and Disability Index (SPADI), Short Form 36 Healthsurvey Questionnaire (SF-36), flexor peak torque (FPT) and extensor peak torque (EPT) in pre and post treatment.ResultsA total of 59 patients with SAIS were enrolled. No exfoliating cases. There were 31 cases in the observed group and 28 cases in the control group. Pre-treatment, there were no significant difference in FPT, EPF, VAS, SPADI and SF-36 between the two groups (P>0.05). Post-treatment, there were no significant difference in EPT and VAS between the two groups (P>0.05); FPT [(62.65±10.17) N·m], SPADI [(53.18±10.25) points] and SF-36 [(35.54±11.39) points] in the observed group were significantly improved compared with the control group [(56.28±9.55) N·m, (61.05±9.41) points, (42.65±10.74) points] (t=2.473, 3.061, 2.460; P=0.014, 0.003, 0.017); FPT in both groups, and EPT in the observed group were improved compared with that of the pre-treatment (P<0.05); the EPT of the control group was improved compared with that of the pre-treatment, but the difference was not statistically significant (P>0.05); VAS, SPADI and SF-36 in the two groups were improved compared with those of the pre-treatment (P<0.05).ConclusionsCore endurance isokinetic strength training could improve the core stability of subacromial impingement syndrome patients. Satisfactory musculoskeletal dynamic chain plays a vital role in subacromial impingement syndrome rehabilitation.