Objective To compare the short-term efficacy and long-term survival of patients with non-small cell lung cancer (NSCLC) treated by uniportal or three portal thoracoscopic radical resection. Methods A total of 388 patients who underwent uniportal or three portal thoracoscopic radical resection of lung cancer in the Department of Thoracic Surgery of Anhui Chest Hospital from 2015 to 2016 were analyzed retrospectively. The patients were divided into two groups including an uniportal group and a three portal group according to the procedure. The clinicopathological features, perioperative data and long-term survival of the two groups were compared. Results Finally, we included 205 patients with 105 males and 100 females at an average age of 58.73±10.93 years. There were 102 patients in the uniportal group and 103 patients in the three portal group. There was no statistical difference in clinicopathological features between the two groups (P>0.05). But compared with the three portal group, the uniportal group had less postoperative drainage, shorter postoperative catheterization time and postoperative hospital stay (P<0.05). There was no statistical difference in the number of lymph node dissection stations between the two groups (P=0.058). The pain score at 24 hours after operation in the uniportal group was significantly lower than that in the three portal group (P<0.001). There was no statistical difference in the total incidence of complications and the incidence of pulmonary complications between the two groups (P=0.161 and P=0.275). The median survival period and the 1st, 3rd, and 5th year survival rate in the uniportal group was 63.0 months and 95.0%, 75.2%, 51.5%, respectively. The median survival period and the 1st, 3rd, and 5th year survival rate in the three portal group was 61.0 months and 89.3%, 70.9%, 50.5%, respectively. There was no satistical difference in the survival results between the two groups (P=0.440). Conclusion Uniportal thoracoscopic radical resection of lung cancer is more minimally invasive and safe and effective in the treatment of NSCLC. It can make patients recover faster after operation.
Totally thoracoscopic surgery is a branch of minimally invasive cardiac surgeries, and its operational indicators are expanding with the development of the medical and imaging devices compared with median sternotomy and other minimally invasive cardiac surgeries (such as thoracoscope-assisted small incision surgery and robotic surgery). The learning curve is significantly shortened through the professional technique training. Totally thoracoscopic cardiac surgery has many advantages, such as minor trauma, few serious complications, fast recovery, high patient acceptance and being suitable to our country's current situation. Therefore it will be one main direction of minimally invasive cardiac surgery. This article mainly introduced the current status of totally thoracoscopic technology in the field of cardiac surgery in China.
Objective To evaluate the safety and efficacy of the operation performed under the video-assisted thoracoscope to release the anterior part of the spine of the patient with severe adolescent idiopathic scoliosis (AIS). Methods From April 2004 to July 2006, 24 patients with AIS (Illness course, 1.5-9 years; Lenke Ⅰ in 17 patients, Lenke Ⅱ in 7; right scoliosis in 22, left scoliosis in 2), among whom there were 9 males and 15 females, with an average age of 14.7 years (range, 11-21 years) at the time of the operation. Before operation, the thoracic vertebral Cobb anger at the coronal plane was averaged 78.3°(range, 65-125°). All the patients had normal muscle strength and muscle tension in their lower limbs, but 5 of the patients had a decrease of the superficial sensation in their lower limbs. All the patients had a moderately or severely decreased lung reserve function. Under general anesthesia, the patient was placed in the lateral position to set up a work channel for thoracoscopy. The releasing of the thoracic intervertebral space and the confluence of the bone grafts were performed. During Stage Ⅰ or Stage Ⅱ, the orthopedic procedures for the posterior part of the scoliosis spine, the internal fixation, and the confluence ofthe bone grafts were completed. ResultsAll the patients survived the periodof perioperation. During operation, there was a hemorrhage of 50-200 ml, averaged 100 ml, with a postoperative thoracic closely-drained fluid of 100-150 ml. The incision was healed by the first intention. Each patient underwent the releaseof 4-6 intervertebral spaces, with an average of 5.5 spaces released. The average coronal Cobb angle was 45.6°(range, 25-75°). The physiological curvatureat the sagittal plane was normal, with an improved shape of the spine. The follow-up for 3-18 months averaged 9.3 months revealed that the bilateral pulmonary markings were clear, with confluence of the orthopedic segment of the spine. The patients could live and work normally, and had a significantly-improved psychological condition and an active social participation because of their improved appearance. Conclusion The releasing of the anterior part of the spine under the video-assisted thoracoscope can effectively release the adolescent idiopathic scoliosis and improve the flexibility of the spine, with a smaller degree of the surgical wound and a faster and clearer exposure of the spinal column during operation.
Objective To investigate the gastrointestinal(GI) protective effect of Omeprazole on children undergoing thoracoscopic heart surgery with cardiopulmonary bypass (CPB). Methods One hundred and twenty seven patients who were scheduled for cardiac surgery with CPB were randomly equally divided into three groups. Group A and B underwent thoracoscopic heart surgery, while the control group underwent conventional heart surgery by sternotomy. Before CPB, group A was treated with Omeprazole 10mg added to the priming solution.? Group B and the control group were treated by adding the same amount of normal saline (to the priming solution). pH and red blood cell count of gastric secretion and serum gastric level (Assay Designs ELISA) were measured at the following intervals: before CPB, 30 minutes into CPB, at termination of CPB,4 and 24 hours after termination of CPB. Results Compare to prior to CBP, the value of the gastric pH in group A was significantly higher (Plt;0.01), and that of group B was significantly lower (Plt;0.05)at the end of CPB. The same value in the control group was significantly lower (Plt;0.05)4h, after the end of CPB. Compared to prior CPB, the mean red blood cell count of gastric secretion and serum gastric level were significantly descent (Plt;0.01) in all there group post CBP. Compare to the control group, the mean gastric pH level in group A was significantly elevated at all time intervals post CBP; while the mean gastric secretin red blood cell count was significantly decreased. The mean serum level in group A 30 min post CBP was significantly lower than that in group B and the control group. Compared to the control group, the mean gastric pH level was significantly lower in group B but returned to the pre-CPB level in 24 h. The mean gastric secretin red blood cell amount and serums gastric level in group B at all time intervals were significantly decreased compare to those of the control group. Conclusion Thoracoscopic heart surgery of children with CPB
ObjectiveTo study the effect of preoperative oral administration of olive oil in the patients with laparoscopic resection of esophageal carcinoma and to expose the advantages of alimentary duct in operation. MethodsWe retrospectively analyzed the clinical data of 136 patients in our hospital from June 2013 through June 2015 year. There were 83 males and 53 females at age of 58.3±7.6 years. The patients were given oral olive oil 100 ml at preoperative 12 hours. ResultsAll patients completed surgery successfully without transfer to open chest. Operation of thoracic duct filling was transparent, milky white, and with clear exposure. Thoracic duct was retained successfully in the 131 patients. It was found that intraoperative injury during separation of thoracic duct due to tumor invasion in 5 patients. These patients were treated with by titanium clipping. All the patients were with chest tube drainage for 3-5 d. Average drainage volume at postoperative 24 hours was 150±35 ml. Postoperative total drainage volume was 500±130 ml. None of postoperative chylothorax was found. Postoperative average hospitalization time was 9±2 d. ConclusionEsophageal cancer preoperative oral administration of olive oil is simple, safe, effective, no injury, and with clear exposure in thoracic duct in operation. Injury of the thoracic duct is reduced. The integrity of thoracic duct is preserved. Normal glucose and lipid metabolism is retained. Therefore, it is a good choice in preoperative preparation for esophageal cancer patients. It is worth popularization and application.
ObjectiveTo summarize the clinical experience of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma. MethodWe retrospectively analyzed the clinical data of 38 patients with esophageal carcinoma undergoing thoracoscopic and laparoscopic esophagectomy in Central Hospital of Chongqing Three Gorges between March 2011 and March 2013. There were 25 males and 13 females aged 64.25±7.68 years (ranged 45-79 years). The esophagus was freed and the lymph nodes were cleaned under the thoracoscope in the left lateral position. Then the stomach was freed under laparoscope and lifted up to anastomose with the esophagus through the passageway behind the sternal bone. ResultsAll surgical process progressed successfully without intraoperative death or major hemorrhage. The total operating time ranged from 250 to 340 minutes. The intraoperative hemorrhage ranged from 80 to 350 ml. The number of lymph nodes cleaned ranged from 7 to 15 (10.24±2.04) and a total of 8 patients were found of tumor metastasis. Postoperative stage grading indicated 8 patients of T1N0M0, 16 patients of T2N0M0, 5 patients of T2N1M0, 6 patients of T3N0M0 and 3 patients of T3N1M0. Postoperative complications included chylothorax in 1 patient, pulmonary infection in 4 patients, and cervical anastomotic leakage in 4 patients. All 38 patients were followed up for 3 to 12 (6.31±2.18) months, and 1 patient was lost. Two patients died from cervical anastomotic leakage resulting in chest infection. The other all achieved recoveries without metastatic or recurrence of tumor. ConclusionThe intraoperative and postoperative complications of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma are less frequently than traditional surgery, so it's worthy of promotion in large regional general hospitals.
ObjectiveTo systematically review the postoperative recovery of lung function in patients with early stage non-small cell lung cancer (NSCLC) after different operation, such as lobectomy versus segmentectomy and video-assisted thoracoscopic surgery (VATS) versus traditional open chest surgery.MethodsClinical studies about effect of different surgical methods on lung function in patients with early NSCLC were searched from PubMed, EMbase, The Cochrane Library, CBM and CNKI databases from inception to October 1st, 2016. Two researchers independently screened literature, extracted data and evaluated the risk of bias of included studies, and then meta-analysis was conducted by RevMan 5.3 and MetaAnalyst software.ResultsA total of 25 studies involving 2 924 patients were included. The results of meta-analysis showed that: compared with lobectomy group, one-second rate difference (ΔFEV1%) (MD=–0.03, 95%CI –0.03 to –0.03, P<0.001) and predictive value of forced vital capacity difference (ΔFVC%) (MD=–0.09, 95%CI –0.11 to –0.06, P<0.001) of preoperative to postoperative in segmentectomy group were higher. However, there was no significant difference between two groups in first second forced expiratory volume difference (ΔFEV1) (MD=0.01, 95%CI –0.10 to 0.11, P=0.92). Compared with thoracotomy group, VATS group had lower ΔFEV1 (MD=–0.19, 95%CI –0.27 to –0.10, P<0.0001), ΔFVC (MD=–0.20, 95%CI –0.37 to –0.03, P=0.02), ΔFEV1% (MD=–0.03, 95%CI –0.06 to –0.01, P<0.001) of preoperative to postoperative (≤3 months), and maximum minute ventilation (ΔMVV) (MD=–5.59, 95%CI –10.38 to –1.52, P=0.008) of preoperative to postoperative (≥6 months). However, there were no statistically significant differences in difference of carbon monoxide diffusion rate (ΔDLCO%) (MD=–0.04, 95%CI –0.09 to 0.02, P=0.16), ΔFEV1% (MD=–0.02, 95%CI –0.06 to 0.02, P=0.32) and ΔFEV1 (MD=1.13, 95%CI –0.92 to 3.18, P=0.28).ConclusionThe protective effect of segmentectomy on postoperative pulmonary function is better than that of lobectomy. VATS has a protective effect on the ventilation function within 3 months and 6 months after surgery. Due to limited quantity and quality of included studies, the above conclusions are needed to be validated by more high quality studies.
ObjectiveTo introduce a new type thoracic vest designed according to the incision characteristics of female patients undergoing totally thoracoscopic cardiac surgery.MethodsSixty-one female patients undergoing totally thoracoscopic cardiac surgery from February 2019 to May 2020 in our department were enrolled. All female patients had hypermastia and (or) mastoptosis which covered the incision. They were randomly divided into a research group (group A, n=32) and a control group (group B, n=29). The group A used the new type thoracic vest, while the group B used the traditional single shoulder belt. The degree of satisfaction, visual analogue scale (VAS) score 24 hours after the thoracic drainage tube removed, the average time-consuming of dressing change, dressing frequency and the incision infection rate were compared between two groups.ResultsThe degree of satisfaction in the group A was higher than that of the group B (P<0.001). The VAS scores of pain, average time-consuming of dressing change and dressing frequency in the group A were less or lower than those of the group B (P<0.001). There was no statistical difference in the incision infection rate between the two groups (P=0.214), but incision infection rate of the group A was lower than that of the group B.ConclusionThe new type thoracic vest seems to be more beneficial for patients than traditional single shoulder belt. It is easy to use, increases the psychological satisfaction of patients, reduces the pain and the incision infection and improves work efficiency, which is worthy of clinical application.
Objective To summarize the early experience of modified Nuss procedure with thoracoscope for repairing pectus excavatum in children. Methods Fiftythree pediatric pectus excavatum were treated by modified Nuss procedure with thoracoscope from June 2004 to July 2006, theage ranged from 2.4 to 16.0 years, the average age was 8.1 years. Thirtysix patients were symmetric pectus excavatum and 17 patients were asymmetric pectus excavatum. Results The operation in all patients were successful, the average blood loss was less than 10ml. Pericardium perforation occurred in 2 earlier patients during the operation, pneumothorax occurred in 6 patients postoperatively,pleural effusion occurred in 3 patients, and all resolved by corresponding treatments. The average hospital length of stay was 5.5 days. All patients had a satisfied deformity correction and no needs of transfusion. The depression was thoroughly corrected in 48 patients, residual depression was less than 20% of preoperative degrees in 5 patients. Therapeutic results evaluation showed excellent in 46 patients and good in 7 patients. All patients were followed up in 1-25 months without any complaints, the activity ability was same as normal children; there were no bar displacement and injury event occurred. The bar had been removed in 1 patient 24 months after surgery who still kept in excellent results. Conclusion Modified Nuss procedure is easy to be performed with minimal invasion and good shortterm results. Thoracoscopic visualization facilitates the safety of this technique. It is recommendable to be tried and extended applied.
ObjectiveTo analyze the operation outcomes and learning curve of uniportal video-assisted thoracoscopic surgery (VATS).MethodsAll consecutive patients who underwent uniportal VATS between November 2018 and December 2020 in Shangjin Branch of West China Hospital of Sichuan University were retrospectively enrolled, including 62 males and 86 females with a mean age of 50.1±13.4 years. Operations included lobectomy, segmentectomy, wedge resection, mediastinal mass resection and hemopneumothorax. Accordingly, patients' clinical features in different phases were collected and compared to determine the outcome difference and learning curve for uniportal VATS.ResultsMedian postoperative hospital stay was 5 days, and the overall complication rate was 8.1% (12/148). There was no 30-day death after surgery or readmissions. Median postoperative pain score was 3. Over time, the operation time, incision length and blood loss were optimized in the uniportal VATS lobectomy, the incision length and blood loss increased in the uniportal VATS segmentectomy, and the postoperative hospital stay decreased in the uniportal VATS wedge resection.ConclusionUniportal VATS is safe and feasible for both standard and complex pulmonary resections. While, no remarkable learning curve for uniportal VATS lobectomy is observed for experienced surgeon.