Because of the characteristics such as accurate, efficient and individuation, 3D printing is being widely applied to manufacturing industry, and being gradually expanded into the medical field. Diseases of chest wall is a common type in thoracic surgery, and surgery is a proper treatment to this kind of disease. For the past few years, 3D printing is being gradually applied in surgery of chest wall diseases. The article mainly makes a statement of two parts that including the possibility to apply 3D printing including chest wall reconstruction and chest wall orthopedic, and to analyze the possibility and application prospect of applying 3D printing to the chest wall disease.
Objective To investigate the current development status of chest wall surgery at all levels of hospitals in Sichuan Province, as well as to provide evidence for the promotion of chest wall surgery. Methods We conducted a questionnaire study to investigate chest wall surgery at all levels of hospitals in Sichuan Province and to collect suggestions for chest wall surgery development from thoracic surgeons attending the meeting of the Sichuan International Medical Exchange & Promotion Association from September 2021 to January 2022. Results A total of 128 questionnaires were issued, with 97 (75.8%) of them being valid. According to the survey results, hospitals with grade A secondary or higher in Sichuan Province performed chest wall surgery. Chest wall surgery accounted for 14.3% of thoracic surgery, with 70.4% being chest wall trauma surgeries, 11.6% being chest wall tumor surgeries, 10.5% being chest wall infection surgeries, and 7.5% being chest wall deformity surgeries. Chest wall surgery accounted for 9.3% of thoracic surgery in the grade A tertiary hospitals, primarily for chest wall trauma and tumor; 23.1% in grade B tertiary hospitals, primarily for chest wall trauma and tumor; and 50.7% in grade A secondary hospitals, primarily for chest wall trauma and infection. Totally 96.9% of hospitals supported the establishment of a subspecialty in chest wall surgery. Suggestions for advancing chest wall surgery included: enhancing communication and cooperation (e.g. holding academic conferences, training courses), the establishment of the chest wall surgery association or consortium, and the formulation of regulations and guidelines or consensus, etc. Conclusion Chest wall surgery has been performed at all levels of hospitals in Sichuan Province. The relevant guidelines can be made based on the related academic associations, thus boosting the development of chest wall surgery in the future.
Abstract: Objective To investigate the value of videoassisted thoracoscopic surgery (VATS) in the treatment of myasthenia gravis (MG) by comparing the early clinical outcomes of extensive thymectomy of VATS and median sternotomy. Methods 195 patients who received extended thymectomy for MG from July 1998 to May 2007 in our department were divided into two groups by operative approach, 83 patients in the VATS group (from April 2002 to May 2007) and 112 patients in the full median sternotomy group(from July 1998 to May 2007). The clinical features, such as operative time, operative blood loss, postoperative drainage, the incidence of crisis, duration of crisis (time of mechanical ventilation), were retrospectively analysed by independent samples t test or chisquare test to evaluate the early outcomes.Results The postoperative drainage in the VATS group was more than that in the median sternotomy group (164.65±38.19ml vs. 98.26±26.84ml, P=0.023), and the operative blood loss in the VATS group was less than that in the median sternotomy group（53.24±11.69ml vs. 97.37±24.61ml,P=0.036）. The incidence of crisis in the VATS group was 4.82%（4/83），which was less than that in the median sternotymy group ［13.39%(15/112), P=0.046,OR=3.054］. And the persistence time of mechanical ventilation for post-operative crisis in the VATS group was much shorter than that in median sternotomy group （75.33±39.31h vs. 189.20±89.74h, P=0.012）. Conclusion VATS extended thymectomy for myasthenia gravis is safe and less invasive. It can decrease the incidence of crisis and the time of mechanical ventilation of crisis, as well as decreasing operative blood loss.
ObjectiveTo explore the safety and effectiveness of video-assisted thoracoscopic surgery (VATS) pneumonectomy for bronchiectasis.MethodsThe clinical data of 164 patients undergoing VATS pneumonectomy or open thoracotomy for bronchiectasis in our hospital from March 2002 to July 2012 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods: a thoracotomy group (122 patients, 63 males, 59 females) and a thoracoscopic surgery group (42 patients, 15 males, 27 females). Surgical and follow-up indicators were compared between the two groups.ResultsThere was no difference between the two groups in the blood loss, operation time, perioperative mortality or complication. However patients undergoing VATS had shorter length of postoperative stay than those undergoing thoracotomy (6.9±2.6 d vs. 8.1±3.1 d, P=0.030). In the thoracoscopic surgery group, 3 patients were lost to follow-up and in the thoracotomy group, 5 patients were lost to follow-up. In a median follow-up of 51 months (ranging from 2 to 116 months), 36 patients (92.3%) fully recovered with no sputum or haemoptysis and 3 (7.7%) partially recovered with a reduced sputum or haemoptysis in the thoracoscopic surgery group; 105 (89.7%) fully recovered with no sputum or haemoptysis, 10 (8.5%) partially recovered with a reduced sputum or haemoptysis while 2 (1.7%) without any improvement in the thoracotomy group with no statistical difference (P=0.700).ConclusionVATS pneumonectomy for bronchiectasis is equivalent to thoracotomy in terms of safety and effectiveness, and can be used as an alternative surgical procedure for the treatment of bronchiectasis.
Objective To analyze the perioperative outcomes of uniportal thoracoscopic lobectomy compared with three-port thoracoscopic lobectomy. Methods Data were extracted from the Western China Lung Cancer Database, a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University. Perioperative outcomes of the patients who underwent uniportal or three-port thoracoscopic lobectomy for lung cancer during January 2014 through April 2021 were analyzed by using propensity score matching. Altogether 5 817 lung cancer patients were enrolled who underwent thoracoscopic lobectomy (uniportal: 530 patients; three-port: 5 287 patients). After matching, 529 patients of uniportal and 1 583 patients of three-port were included. There were 529 patients with 320 males and 209 females at median age of 58 (51, 65) years in the uniportal group and 1 583 patients with 915 males and 668 females at median age of 58 (51, 65) years in the three-port group. Results Uniportal thoracoscopic lobectomy was associated with less intraoperative blood loss (20 mL vs. 30 mL, P<0.001), longer operative time (115 min vs. 105 min, P<0.001) than three-port thoracoscopic lobectomy. No significant difference was found between the two groups regarding the number of lymph node dissected, rate of conversion to thoracotomy, incidence of postoperative complication, postoperative pain score within 3 postoperative days, length of hospital stay, or hospitalization expenses. Conclusion Uniportal video-assisted thoracoscopic lobectomy is safe and effective, and the overall perioperative outcomes are comparable between uniportal and three-port strategies, although the two groups show differences in intraoperative blood loss.
Objective To identify the risk factors for postoperative recurrence of peripheral solid small-nodule lung cancer (PSSNLC) (T≤2 cm), and to explore the effects of surgery types on prognosis. Methods We extracted data from Western China Lung Cancer Database (WCLCD), a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University, and Surveillance, Epidemiology, and End Results (SEER) database for peripheral solid small-nodule lung cancer patients (T≤2 cm N0M0, stageⅠ) who underwent surgerybetween 2005 and 2016. We used univariable and multivariable logistic regression to analyze risk factors for recurrence of PSSNLC. We applied propensity-score matching to compare the long-term results of segmentectomy and lobectomy, as well as the survival of patients from WCLCD and SEER. We finally included 4 800 patients with PSSNLC (T≤2 cm N0M0) (WCLCD∶SEER=354∶4 446). We matched 103 segmentectomies and 350 lobectomies in T≤1 cm, and 280 segmentectomies and1 067 lobectomies in 1 cm<T≤2 cm at a ratio of 1∶4 according to the propensity scores. Results The results of multivariable logistic regression showed that older age (HR=1.04, 95%CI 1.03-1.05, P<0.001), male (HR=1.60, 95%CI 1.37-1.88, P<0.001), squamous carcinoma (HR=1.65, 95%CI 1.40-1.95, P<0.001), lymph node removed (HR=0.97, 95%CI 0.96-0.99, P<0.001) were risk factors for recurrence after surgery. We found that segmentectomy and lobectomy could reach similar survival in PSSNLC patient with either T≤1 cm or 1 cm<T≤2 cm. Analyses of 1 441 patients with PSSNLC after matching (WCLCD∶SEER=325∶1 116) indicated that the 5-year overall survival rate of the patients in WCLCD was better than that in SEER database ( 89.8% vs. 77.1%, P<0.001). Conclusion Older age, male, squamous carcinoma, and lymph node removed are the risk factors for recurrence of PSSNLC. Segmentectomy shows similar survival in PSSNLC patient with either T≤1 cm or 1 cm<T≤2 cm N0M0. The patients in the WCLCD shows better survival compared with of the patients in the SEER database.