Objective To explore the minimal invasiveness and practability of combined video-assisted thoracic surgery (VATS) with two trocars and endoscopic ultrasonography (EUS) in the treatment of esophageal leiomyoma. Methods Between February 2007 and February 2012, we retrospectively analysed the clinical data of 166 patients who underwent various surgeries for the treatment of esophageal leiomyoma. Among them, 62 received routine thoracotomy (group A), 49 accepted conventional VATS surgery with three trocars (group B), and 55 underwent combined VATS surgery with two trocars and EUS (group C). Then, we summarized the clinical indexes of patients in all the three groups for further comparative analysis. Results There was no significant difference among the three groups in age, gender, and lesion location, origin level and size (P > 0.05). There were significant differences between group A and C in blood loss, surgery time, intraoperative localization, postoperative incision pain, hospitalization expenses, length of hospital stay, fasting time, pulmonary infection, and the complications during the follow-up (P < 0.05). There were significant differences between group C and B in blood loss, surgery time, intraoperative localization, fasting time and pulmonary infection (P < 0.05). Conclusion Combined VATS surgery with two trocars and EUS is safe, minimally invasive, thorough with few complications, which is worthy of clinical promotion.
ObjectiveTo investigate the influence of different temperatures of distilled water on the general sensation of patients during endoscopic ultrasonography (EUS) examination. MethodsSixty patients who received EUS examination were randomly assigned to trial group and control group. The trial group used (40±1) ℃ distilled water, while the control group accepted 26-28℃ distilled water. The operating time and the grade of discomfort symptoms such as general discomfort, abdominal pain, nausea, vomiting and terror were observed. ResultsSignificant differences in general discomfort, nausea, vomiting and terror were found between the two groups (P ＜ 0.001) . Abdominal pain was not found in either group. The examination time in each group did not show any significant difference (P ＞ 0.05) . ConclusionDifferent distilled water temperatures significantly influence the sensation of patients during the EUS examination, and distilled water with a temperature of (40±1) ℃ is able to relieve the discomfort of patients.
Objective To evaluate the accuracy and investigate the influence factors of preoperative T staging by endoscopic ultrasonography (EUS) in patients with postoperative pathological stage of T2 esophageal carcinoma (EC). Methods A total of 206 patients with EC underwent EUS and curative operation in Henan Tumor Hospital from March 2015 to January 2016 were enrolled, among whom 81 patients were identified with pathological stage of T2 EC followed by esophageal resection without induction therapy. There were 59 males and 22 females, with a mean age of 63.9 years and meadian age of 63.0 years. We reviewed the medical records of the 81 patients and compared EUS findings with histopathologic results according to clinicopathologic factors. Results The overall accuracy of EUS for evaluating staging of T2 EC was 61.7% (50/81), while 38.3% (31/81) were overstaged by EUS. Accuracy differed between the accurate staging group and over staging group (P=0.023). There was no significant difference in sex, age, tumor location and shape, histologic type, tumor differentiation or lymph node metastasis between two groups. Conclusion EUS is highly overstaged in the diagnosis of postoperative pathological stage of T2 EC. Higher postoperative pathological TNM stage appears to be a factor of EUS overstaging in patients with postoperative pathological stage of T2 EC.
ObjectiveTo evaluate the application of dexmedetomidine for moderate sedation in patients undergoing endoscopic ultrasonography.MethodsPatients who were planned to undergo endoscopic ultrasonography in West China Hospital of Sichuan University from February to June 2019 were randomly divided into dexmedetomidine group (trial group) and propofol group (control group). The basic conditions, success rate of endoscopic ultrasound diagnosis and treatment, sedation-related adverse events, implementation of airway management, postoperative comfort evaluation and endoscopic physician satisfaction score of the two groups were compared.ResultsA total of 120 patients were eventually enrolled, 60 in each group. There was no significant difference in the basic conditions of the two groups (P>0.05). The success rate of endoscopic ultrasound diagnosis and treatment in two groups were 100%. There was no significant difference in the incidence of bucking, apnea and bradycardia between the two groups (P>0.05). The incidence of hypotension (15.0% vs. 31.7%), hypoxemia (6.7% vs.20.0%) in the trial group was lower than those in the control group, the differences were statistically significant (P<0.05). The proportion of patients in the trial group who performed airway management was lower than that in the control group (1.7% vs. 28.3%), and the difference was statistically significant (P<0.05). There was no significant difference in postoperative pain score, the first time to get out of bed and postoperative 15-item quality of recovery questionnaire score between the two groups (P>0.05). The incidence of nausea and vomiting at 6 hours after operation (48.3% vs. 3.3%) and 24 hours after operation (10.0% vs. 0.0%) and the time required for recovery of gastrointestinal function ［(201.4±178.4) vs. (148.5±75.7) min］ in the trial group were higher than those in the control group (P<0.05). The median (the lower and upper quartile) of comfort score of patients and satisfaction score of endoscopic physicians were 8 (6, 10) and 8 (7, 9) in the trial group, respectively, and were 10 (9, 10) and 9 (8, 10) in the control group, with statistically significant differences (P<0.05).ConclusionModerate sedation with dexmedetomidine could provide good sedative and analgesic effects in endoscopic ultrasonography. It has little effect on respiration and blood pressure, but the incidence of postoperative nausea and vomiting were higher than deep sedation with propofol. And patient comfort and endoscopic physician satisfaction also need to be improved.