Abstract： Objective To investigate strategies for prevention，early diagnosis，and prompt treatment for acute pulmonary embolism（PE）after video-assisted thoracoscopic surgery（VATS）lobectomy. Methods From January 2007 to November 2010, 1 115 patients with lung cancer underwent VATS lobectomy in the First Affiliated Hospital of Guangzhou Medical College. Among them, 13 patients had acute PE postoperatively, including 6 male patients and 7 female patients with their mean age of 62.3 years（ranging from 42 to 73 years）.All the patients were diagnosed by spiral CT pulmonary artery angiography（SCTPA）, and received anticoagulation therapy with low molecular weight heparin and warfarin. Results The incidence of acute PE after VATS lobectomy was 1.17%（13/1 115）, and the patients with low PE-related early mortality risk accounted for a large proportion（11/13）. There were 12 patients with right-side PE. All the patients’ signs and symptoms were significantly alleviated after administration of anticoagulation therapy. Nine patients received SCTPA review after treatment which showed that their PE had disappeared or been significantly absorbed. No hematological complications including thoracic hemorrhage or wound errhysis occurred after treatment. All surviving patients were followed up for 1 month to 3 months. During follow-up, these patients were alive without PE recurrence. Conclusion SCTPA is the first-choice examination for the diagnosis of acute PE after VATS lobectomy. Prophylaxis against PE and prompt treatment are necessary depending on individual manifestations. VATS lobectomy should be favored as a minimally invasive surgical treatment for patients with lung cancer, for the low incidence of postoperative PE and low PE-related early mortality risk.
ObjectiveTo compare the effects of transthoracic device closure and traditional surgical repair on atrial septal defect systemically.MethodsA systematic literature search was conducted using the PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBM, Wanfang Database up to July 31, 2018 to identify trials according to the inclusion and exclusion criteria. Quality was assessed and data of included articles were extracted. The meta-analysis was conducted by RevMan 5.3 and Stata 12.0 software.ResultsThirty studies were identified, including 3 randomized controlled trials (RCTs) and 27 cohort studies involving 3 321 patients. For success rate, the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.34, 95%CI 0.16 to 0.69, P=0.003). There was no statistical difference in mortality between the two groups (CCT, OR=0.43, 95%CI 0.12 to 1.52, P=0.19). Postoperative complication occurred less frequently in the transthoracic closure group than that in the surgical repair group (RCT, OR=0.30, 95%CI 0.12 to 0.77, P=0.01; CCT, OR=0.27, 95%CI 0.17 to 0.42, P<0.000 01). The risk of postoperative arrhythmia in the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.56, 95%CI 0.34 to 0.90, P=0.02). There was no statistical difference in the incidence of postoperative residual shunt in postoperative one month (CCT, OR=4.52, 95%CI 0.45 to 45.82, P=0.20) and in postoperative one year (CCT, OR=1.03, 95%CI 0.29 to 3.68, P=0.97) between the two groups. Although the duration of operation (RCT MD=–55.90, 95%CI –58.69 to –53.11, P<0.000 01; CCT MD=–71.68, 95%CI –79.70 to –63.66, P<0.000 01), hospital stay (CCT, MD=–3.31, 95%CI –4.16, –2.46, P<0.000 01) and ICU stay(CCT, MD=–10.15, 95%CI –14.38 to –5.91, P<0.000 01), mechanical ventilation (CCT, MD=–228.68, 95%CI –247.60 to –209.77, P<0.000 01) in the transthoracic closure group were lower than those in the traditional surgical repair group, the transthoracic closure costed more than traditional surgical repair during being in the hospital (CCT, MD=1 221.42, 95%CI 1 124.70 to 1 318.14, P<0.000 01).ConclusionCompared with traditional surgical repair, the transthoracic closure reduces the hospital stay, shortens the length of ICU stay and the duration of ventilator assisted ventilation, while has less postoperative complications. It is safe and reliable for patients with ASD within the scope of indication.