目的:探讨儿童糖尿病患者的营养治疗方法以提高治疗效果。 方法:随机选择20例胰岛素依赖型儿童糖尿病患者,结合年龄、体重、病情、胰岛素用量、营养状况、生长发育需要设计个体化营养治疗方案。结果:通过营养治疗,除1例患儿家属在病情控制相对稳定,但血糖未有效控制提前出院外,其余19例患者均坚持营养治疗。治疗前后,随机血糖、餐后2 h血糖差异有统计学意义,P＜0.05;糖化血红蛋白差异无统计学意义。结论:个体化的营养治疗有助于儿童糖尿病患者血糖控制,并能促进儿童的生长发育及提高生活质量。
ObjectiveTo evaluate the timing of chest tube removal after resection of lung or esophageal cancer.MethodsA prospective randomized controlled study was performed. From June 2014 to February 2016, 150 patients suspected with the cancer of lung or esophagus undergoing neoplasm resection and lymph node dissection in our single medical unit were classified into 3 groups according to the random number generated by SPSS17.0 with 50 patients in the each group. The drainage volume for chest tube removal was ≤100 mL/d in the group Ⅰ, 101–200 mL/d in the group Ⅱ, and 201–300 mL/d in the group Ⅲ. Chest radiography was performed 48 hours following chest tube removal. ResultsThe 127 patients (108 males and 19 females, with an average age of 59.0±8.7 years) eligible for analysis consisted of 45 patients in the group Ⅰ, 41 in the group Ⅱ, and 41 in the group Ⅲ respectively after the 23 patients were excluded from this study who were diagnosed as benign lesions through intraoperative frozen pathology (n=20) and postoperative complications (empyema in 2 patients and chylothorax in 1 patient). Age, sex, types of neoplasm, and comorbidities except procedures via video-assisted thoracic surgery (and laparoscopy) showed no significant difference among the three groups (P>0.05). No mortality was observed in this study. There were postoperative complications in 6 patients and its distribution had no statistical differences among the three groups (P>0.05). The mean postoperative duration of chest tube was 181.0±68.2 h, 111.0±63.1 h, 76.0±37.2 h, the mean drainage volume was 1 413.0±500.9 mL, 1 005.0±686.4 mL, 776.0±505.8 mL, and the mean hospital stay time following chest tube removal was 19.0±9.7 d, 14.0±8.0 d, 9.0±4.8 d in the group Ⅰ,Ⅱ and Ⅲ, respectively; there was a significant difference among the three groups (P=0.000). The 13 patients required reintervention after chest tube removal due to pleural effusion accumulation and there was no difference among the three groups (P>0.05). Chest pain relieved essentially after chest tube removal in all patients.ConclusionA drainage volume of ≤300 mL/d as a threshold for chest tube removal after resection of lung or esophageal cancer can shorten postoperative hospital stay and accelerate early recovery of the patients.
Objective To compare the perioperative outcomes of atypical segmentectomy between robotic-assisted thoracoscopic surgery (RATS) and conventional video-assisted thoracoscopic surgery (VATS) in early-stage non-small cell lung cancer (NSCLC). MethodsThe data of patients who underwent minimally invasive anatomic atypical segmentectomy in our hospital from October 2016 to December 2021 were collected. These patients were divided into a RATS group and a VATS group according to the operation method. Propensity score (PS) matching was used to select patients with close clinical baseline characteristics, and the perioperative results of the two groups were compared. ResultsA total of 1 048 patients were enrolled, including 320 males and 728 females, with a mean age of 53.51±11.13 years. There were 277 patients in the RATS group and 771 patients in the VATS group. After 1∶1 PS matching, 277 pairs were selected. Both groups were well balanced for age, sex, smoking history, body mass index, Charlson comorbidity index, pulmonary function, tumor size, tumor location, and histological type. All patients were R0 resection, and there were no deaths within 30 days after surgery. The RATS group had shorter operative time [85 (75, 105) min vs. 115 (95, 140) min, P<0.001] and less blood loss [50 (30, 100) mL vs. 60 (50, 100) mL, P=0.001]. There were no statistical differences between the two groups in lymph node resection, conversion to thoracotomy, thoracic drainage time, total amount of thoracic drainage or postoperative complications (P>0.05). ConclusionBoth RATS and VATS atypical segmentectomies are safe and feasible for early-stage NSCLC. RATS can effectively shorten the operative time, and reduce blood loss.
ObjectiveTo explore the clinical efficacy of thoracoscopy-assisted modified Nuss procedure for pectus excavatum (PE) in children.MethodsThe clinical data of patients with PE who underwent thoracoscopy-assisted modified Nuss procedure from October 2013 to October 2020 in Daping Hospital were retrospectively analyzed.ResultsA total of 86 patients were collected, including 79 males and 7 females with a mean age of 14.03±3.36 years. The operations were performed successfully in all patients without intraoperative cardiac vascular injury or perioperative death. The mean operation time was 87.30±33.45 min, bleeding volume was 19.94±14.60 mL, and the postoperative hospitalization stay time was 6.89±2.59 d. Early postoperative complications included 2 patients of pneumothorax, 2 patients of wound fat liquefaction and infection, 2 patients of bar flipping and displacement. One patient had bar displacement 1 year after the surgery. The total complication rate was 8.14%. All patients were followed up for 3-42 months. The bars were taken out about 36 months after the surgery. According to the evaluation criteria of orthopedic effect, 68 (79.07%) patients were excellent, 10 (11.63%) patients were good, 5 (5.81%) patients were moderate and 3 (3.49%) patients were poor.ConclusionMinimally invasive and individualized shaping via the Nuss procedure for PE children is safe and convenient, with satisfied effect. It is worthy of popularization in the clinic.
ObjectiveTo investigate the feasibility and safety of single utility port Da Vinci robot-assisted lung resection via anterior approach.MethodsThe clinical data of 21 patients who underwent single utility port Da Vinci robot-assisted lung resection from February to March 2021 were retrospectively analyzed. There were 10 males and 11 females, with a median age of 50 (34-66) years. The operation time, blood loss, postoperative hospitalization time, postoperative complications and other indicators were analyzed.ResultsAll patients completed the operation successfully with no transition to thoracotomy or perioperative death. Overall surgery time was 103 (70-200) min, Docking time was 5 (3-10) min, operation time was 81 (65-190) min. The blood loss was 45 (20-300) mL. All patients had malignant tumors, the number of dissected lymph node station was 3 (1-6), and the number of lymph nodes was 5 (2-16). The postoperative indwelling time was 3 (2-5) d. The postoperative hospitalization time was 5 (3-7) d. The pain score for the first 3 days after surgery was 3±1 points.ConclusionSingle utility port robot-assisted lung resection via anterior approach is safe, less traumatic, more convenient and effective, which can be gradually promoted and applied to clinical trials.
ObjectiveTo summarize the experience of robot-assisted lung basal segmentectomy, and analyze the clinical application value of intersegmental tunneling and pulmonary ligament approach for S9 and/or S10 segmentectomy. MethodsThe clinical data of 78 patients who underwent robotic lung basal segmentectomy in our hospital between January 2020 to May 2022 were retrospectively reviewed. There were 32 males and 46 females with a median age of 50 (33-72) years. The patients who underwent S9 and/or S10 segmentectomy were divided into a single-direction group (pulmonary ligament approach, n=19) and a bi-direction group (intersegmental tunneling, n=19) according to different approaches, and the perioperative outcomes between the two groups were compared. ResultsAll patients successfully completed the operation, without conversion to thoracotomy and lobectomy, serious complications, or perioperative death. The median operation time was 100 (40-185) min, the blood loss was 50 (10-210) mL, and the median number of dissected lymph nodes was 3 (1-14). There were 4 (5.1%) patients with postoperative air leakage, and 4 (5.1%) patients with hydropneumothorax. No patient showed localized atelectasis or lung congestion at 6 months after the operation. Further analysis showed that there was no significant difference in the operation time, blood loss, thoracic drainage time, complications or postoperative hospital stay between the single-direction and bi-direction groups (P>0.05). However, the number of dissected lymph nodes of the bi-direction group was more than that of the single-direction group [6 (1-13) vs. 5 (1-9), P=0.040]. ConclusionThe robotic lung basal segmentectomy for pulmonary nodules is safe and effective. The perioperative results of robotic S9 and/or S10 complex segmentectomy using intersegmental tunneling and pulmonary ligament approach are similar.
ObjectiveTo evaluate the feasibility and clinical value of robot-assisted lung segmentectomy through anterior approach.MethodsWe retrospectively analyzed the clinical data of 77 patients who underwent robotic lung segmentectomy through anterior approach in our hospital between June 2018 to October 2019. There were 22 males and 55 females, aged 53 (30-71) years. Patients' symptoms, general conditions, preoperative imaging data, distribution of resected lung segments, operation time, bleeding volume, number of lymph node dissected, postoperative duration of chest tube insertion, drainage volume, postoperative hospital stay, postoperative complications, perioperative death and other indicators were analyzed.ResultsAll operations were successfully completed. There was no conversion to thoracotomy, serious complications or perioperative death. The postoperative pathology revealed early lung cancer in 48 patients, and benign tumors in 29 patients. The mean clinical parameters were following: the robot Docking time 1-30 (M=4) min, the operation time 30-170 (M=76) min, the blood loss 20-400 (M=30) mL, the drainage tube time 2-15 (M=4) days, the drainage fluid volume 200-3 980 (M=780) mL and the postoperative hospital time 3-19 (M=7) days.ConclusionRobotic lung segmentectomy through anterior approach is a safe and convenient operation method for pulmonary nodules.
ObjectiveTo explore the clinical value of three-dimensional computed tomography bronchography and angiography (3D-CTBA) in robotic lung segmentectomy.MethodsA non-randomized control study was performed and continuously enrolled 122 patients who underwent robotic lung segmentectomy in our hospital from January 2019 to January 2020. 3D-CTBA was performed before operations in 53 patients [a 3D-CTBA group, including 18 males, 35 females, with a median age of 52 (26-69) years] and not performed in the other 69 patients [a traditional group, including 23 males, 46 females, with a median age of 48 (30-76) years]. The clinical data of the patients were compared between the two groups.ResultsAll the patients were successfully completed the surgery and recovered from hospital, with no perioperative death. The baseline characteristics of the patients were not significantly different between the two groups (P>0.05). No significant difference was found in the operative time [120 (70-185) min vs. 120 (45-225) min, P=0.801], blood loss [50 (20-300) mL vs. 30 (20-400) mL, P=0.778], complications rate (17.0% vs. 11.6%, P=0.162), postoperative hospital stay [7 (4-19) d vs. 7 (3-20) d, P=0.388] between the two groups. In the 3D-CTBA group, 5 (9.4%) patients did not find nodules after segmentectomy, and only 1 (1.9%) of them needed lobectomy, but in the traditional group, 8 (11.6%) patients did not find nodules and had to carry out lobectomy, the difference was statistically significant (P<0.05). The follow-up time was 10 (1-26) months, and during this period, there was no recurrence, metastasis or death in the two groups.Conclusion3D-CTBA is helpful for accurate localization of nodules and reasonable surgical planning before operations, and reducing wrong resections in segmentectomy, without increasing the operation time, blood loss and complications. It is safe and effective in anatomical lung segmentectomy.
ObjectiveTo evaluate the feasibility and clinical value of robot-assisted lobectomy through anterior approach.MethodsWe retrospectively analyzed the clinical data of 180 patients who underwent robot-assisted lobectomy through anterior approach in our hospital between April 2017 and February 2018. There were 97 males and 83 females, aged 59.5 (32.0-83.0) years. The clinical effects were analyzed.ResultsOne patient was transferred to thoracotomy due to tumor invasion of adjacent blood vessels and injury to the blood vessels, and there was no perioperative death. There were 8.5 (1.0-35.0) dissected lymph nodes for each patient. The median operation time was 120 (50-360) min, including robot Docking time 5 (1-23) min and robot operation time 65 (7-270) min. The median blood loss was 50 (5-1 500) mL, 132 (73.3%) patients had malignant tumors and median drainage time was 5 (2-30) d. The mean postoperative pain score was 3.4±0.7 points and the postoperative hospital time was 8 (2-32) d. At the median follow-up of 24 months, 11 patients developed recurrence and metastasis, and 3 died.ConclusionRobot-assisted lobectomy through anterior approach is a safe and convenient operation method, which is worthy of clinical application.