ObjectiveTo investigate the relationship between the nodule manifestation of malignant pleural lesions under medical thoracoscopy and pleural fluid biochemistry and tumor marker levels. MethodsA total of 110 patients with malignant pleura, including 90 cases of lung cancer, 18 cases of malignant mesothelioma, 1 case of diffuse large B-cell lymphoma, and 1 case of ovarian serous carcinoma, who were hospitalized in the Department of Respiratory and Critical Care Medicine, East Hospital of Shandong Provincial Hospital from February 2011 to January 2022 were selected as the study subjects. The pleural nodule manifestation was divided into 6 layers were according to the number of pleural nodules in the medical thoracoscopic field, they were divided into 6 layers: non-nodular group, nodular group (pleural nodules of different sizes were distributed); The nodular group was further divided into nodular scattered group (total number of pleural nodules in all fields under thoracoscopy ≤10) and nodular diffuse group (total number of pleural nodules in all fields under thoracoscopy >10); The nodular diffuse group was further divided into the multiple nodules diffused group (the total number of pleural nodules >10 under thoracoscopy and ≤10 nodules in a single microscopic field) and the nodular diffuse patchwork group (the total number of pleural nodules >10 under thoracoscopy and >10 nodules in a single microscopic field). Four biochemical items of pleural fluid, pleural fluid lactate dehydrogenase (LDH), adenosine deaminase (ADA), glucose (GLU), protein quantification (TP) levels and pleural fluid carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125) levels, serum CEA, and serum cytokeratin fragment 19 (CYFRA21-1) levels were measured to compare the expression levels of indicators between the non-nodular group and the nodular group, the nodular scattered group and the nodular diffuse group, the multiple nodules diffused group and the nodular diffuse patchwork group.ResultsThe LDH level in pleural fluid of nodular group was significantly higher than that of non-nodular group (P<0.01). The LDH level in pleural fluid of diffuse nodular group was higher than that of scattered nodular group (P<0.05). Compared to those in multiple nodules diffused group, the levels of LDH and ADA in pleural fluid of nodules patchy diffused group were significantly increased (P<0.01), and the GLU level was decreased (P<0.05). However, there were no statistically significant differences in the length of disease, smoking index, TP in pleural fluid, CEA in pleural fluid, CA125 in pleural fluid, CEA in serum and CYFRA21-1 in serum between the paired groups.ConclusionsThere were differences in the expression levels of LDH, ADA and GLU in pleural fluid of different degrees of malignant pleural lesions. The higher the degree of pleural lesions, the higher the levels of LDH and ADA in pleural fluid and the lower the levels of GLU in pleural fluid.
ObjectiveTo study the clinical results of Mini Maze procedure in atrial fibrillation patients with impaired left ventricular systolic function.MethodsFrom June 2010 to December 2017, 86 atrial fibrillation patients with impaired left ventricular systolic function received Mini Maze procedure including 54 males and 32 females, with an average age of 60.7±5.9 years. Among them, 12 were with paroxysmal, 27 were with persistent and 47 were with long-standing persistent atrial fibrillation. The mean atrial fibrillation duration was 6.5±4.8 years. CHA2DS2-VASc score was 2.2±1.1. The mean diameter of left atrium was 46.9±3.8 mm. The mean diameter of left ventricle was 51.7±4.6 mm. The preoperative ejection fraction was 42.2%±4.7%. All patients received Mini Maze procedure after general anesthesia. The ablation included 3 annular ablations and 3 linear ablations. The left atrial appendage was excised by Endo-Gia. Ablation of Marshall ligament and epicardial autonomic ganglions were made by an ablation pen.ResultsEighty-six patients successfully completed the procedure without transition to thoracotomy. There was no death during the perioperative period. Seventy-seven patients (89.5%) maintained sinus rhythm at discharge. Eighty patients were followed up for 27.2±12.1 months and 72 patients maintained sinus rhythm. The overall postoperative left ventricular ejection fraction was 47.1%±6.2%. The ejection fraction of the postoperative sinus rhythm group was 48.2%±5.8%, and the ejection fraction of the non-sinus group was 41.6%±5.8% (P<0.05). Multivariate regression analysis showed a left atrial diameter (HR=1.485, 95%CI 1.157-1.906, P<0.05) and an increase in ejection fraction over 10% (HR=18.800, 95%CI 1.674-189.289, P<0.05) were closely related to postoperative recurrence. Kaplan-Meier curve analysis showed that the recurrence rate of atrial fibrillation was significantly lower in patients with an increase in postoperative ejection fraction over 10% (P<0.05).ConclusionMini Maze procedure is safe and effective in the treatment of atrial fibrillation patients with left ventricular systolic dysfunction, which helps to improve left ventricular function to prevent the vicious circle of atrial fibrillation and heart failure.
ObjectiveTo explore an effective and safe drainage method, by comparing open thoracic drainage and conventional thoracic drainage for lung cancer patients after thoracoscopic pneumonectomy.MethodsThe clinical data of 147 patients who underwent thoracoscopic pneumonectomy from January 2015 to March 2018 in our hospital were retrospectively analyzed, including 128 males and 19 females. Based on drainage methods, they were divided into an open drainage group (open group) and a conventional drainage group (regular group). The incidence of postoperative complications, chest tube duration, drainage volume at postoperative 3 days, postoperative hospital stay, hospitalization cost and quality of life were compared between the two groups.ResultsPostoperative complication rate was lower in the open group than that in the regular group (10.20% vs. 23.47%, P=0.04). The chest tube duration of the open group was longer compared with the regular group (5.57±2.36 d vs. 3.22±1.23 d, P<0.001). The drainage volume at postoperative 3 days was less in the regular group. In the open group, ambulation was earlier, thoracocentesis was less and re-intubation rate was lower (all P<0.001). The postoperative hospital stay in the regular group was significantly longer than that in the open group (8.37±2.56 d vs. 6.35±1.87 d, P<0.001) and hospitalization cost was significantly higher (66.2±5.4 thousand yuan vs. 59.6±7.3 thousand yuan, P<0.001). Besides, quality of life in 1 and 3 months after operation was significantly better than that in the open group (P<0.001).ConclusionCompared with the regular chest drainage, the effect of open thoracic drainage is better, which can help reduce postoperative complications, shorten the length of hospital stay, reduce the hospitalization cost and improve the quality of postoperative life. It is worthy of clinical promotion.
ObjectiveTo investigate the safety, feasibility and advantages of subxiphoid uni-portal thoracoscopic thymectomy.MethodsClinical data of 65 patients undergoing subxiphoid uni-portal thoracoscopic thymectomy in our hospital from September 2018 to March 2019 were retrospectively analyzed. They were treated as a subxiphoid surgery group, including 36 males and 29 females, aged 49.5 (29-71) years. The incision with the length of about 3 cm was located approximately 1 cm under the xiphoid process. From January 2016 to December 2017, 65 patients received intercostal uni-portal thoracoscopic thymectomy, who were treated as a control group, including 38 males and 27 females, aged 48.9 (33-67) years. All patients who were clinically diagnosed with thymic tumor before surgery were treated with total thymectomy. After surgery, expectoration and analgesia were used.ResultsThere was no statistically significant difference in general clinical data, lesion size, intraoperative blood loss, postoperative catheterization time, postoperative hospital stay and postoperative pathology between the two groups. All operations were successfully completed, and the patients in both groups recovered uneventfully after surgery. Visual analogue scale scores on the 1st, 3rd, 7th and 30th day after surgery in the subxiphoid surgery group were lower than those in the control group.ConclusionThe subxiphoid uni-portal thoracoscopic approach can achieve total thymectomy with less trauma and faster postoperative recovery.
Objective To compare the effect of uniportal and multiportal thoracoscopic lobectomy, and to explore the advantages and applications of uniportal thoracoscopic lobectomy in enhanced recovery after surgery. Methods Totally 169 patients with video-assisted thoracoscopic lobectomy in Department of Thoracic Surgery of Sichuan Cancer Hospital from January to December 2016 were enrolled. There were 99 males and 70 females with age of 60.83±7.24 years. Patients were divided into two groups: a uniportal group (78 patients) and a multiportal group (91 patients) . Patients’ clinical and pathological materials were collected. Postoperative pain, complications and hospital stay, etc of the two groups were compared. Results All patients were successfully discharged without serious postoperative complication or death. Patients in the multiportal group had smaller surgical incisions than that in the uniportal group (3.12±0.73 cm vs. 6.38±1.50 cm, P=0.016). Pain scores at postoperative 24 and 48 hours of the uniportal group were less than those of multiportal group (4.18±1.67 vs. 6.54±1.83, 3.05±1.47 vs. 4.68±1.64, P<0.05). Operation data, postoperative complications and hospital stay were similar in both groups. Conclusion Uniportal video-assisted thoracoscopic lobectomy makes smaller incisions and can further reduce postoperative pain and dosage of morphine. The operation is safe and worthy of wide application in enhanced recoveryafter surgery.
Objective To investigate the current level of resourcefulness and its impact on work engagement among lung cancer patients who have returned to work after video-assisted thoracoscopic surgery (VATS) lung resection. Methods A sample of middle-aged and young lung cancer patients who underwent VATS lung resection at the Department of Thoracic Surgery, West China Hospital of Sichuan University, between March and September 2023 and had returned to work were selected as the study subjects. Data were collected using a general information questionnaire, the Resourcefulness Scale, and the Utrecht Work Engagement Scale (UWES). Univariate analysis and multiple stepwise regression analysis were used to examine the current status of patients’ resourcefulness upon returning to work and its influence on work engagement. Results A total of 219 patients were included in the study, comprising 60 males and 159 females, with a mean age of (43.18±7.55) years. The patients' score for resourcefulness in returning to work was (107.58±14.42) points, and the total score for work engagement was (64.80±12.72) points. A significant positive correlation was observed between the resourcefulness score and the work engagement score (P<0.001). Multiple stepwise regression analysis revealed that factors such as job nature, average monthly household income, postoperative complications, and individuals' level of resourcefulness all significantly influenced the degree of patients' work engagement (all P<0.05).Conclusion The resourcefulness level and work engagement of patients returning to work after VATS lung resection need to be improved.
ObjectiveTo explore the safety and efficacy of thoracoscopic guided thoracic paravertebral block (TPVB) in resection of lung, and to provide strategies for enhanced recovery after surgery of lung surgery. MethodsA total of 180 patients with thoracoscopic surgery of lung (including sublobar resection and lobectomy) hospitalized between May 2021 and June 2023 were included. There were 108 females and 72 males with an average age of (62.15±7.36) years. Patients were divided into 3 groups. Patients received subcutaneous injection of ropivacaine (concentration: 0.375%, dose: 2 mg/kg) on peripheral incision at chest closing were allocated into a group A. Patients received ultrasound-guided injection of ropivacaine (concentration: 0.375%, dose: 2 mg/kg) at the TPVB point after chest closing into a group B. Patients received thoracoscopic guided injection of ropivacaine (concentration: 0.375%, dose: 2 mg/kg) before chest closing at the TPVB point into a group C. The baseline data of each group were compared, and the effectiveness outcomes included perioperative adverse drug reactions, pain scores, postoperative analgesic drug use and postoperative hospital stay were compared among the 3 groups. ResultsThere were no statistical differences in the baseline data of three groups, including age, weight, gender, incidence of previous underlying diseases, operation time, number of surgical incisions, number of drainage tubes inserted, and dosage of sufentanil or propofol used during surgery (P>0.05). There were no adverse anesthesia events in the 3 groups during the operation, the frequency of self-controlled intravenous analgesia pump, the VAS score, the incidence of adverse reactions, and the rate of postoperative analgesic drug use in group C was less or lower than the other two groups (P<0.05). The hospital stay in the group C and group B were lower than that in the group A (P<0.05). ConclusionThoracoscopic guided TPVB can reduce postoperative pain without increasing postoperative side effects, which had accelerated the enhanced recovery after surgery of lung.
Objective To investigate the clinical outcomes of subxiphoid video-assisted thoracoscopic thymectomy for myasthenia gravis. Methods The clinical data of the 85 patients undergoing video-assisted thoracoscopic thymectomy for myasthenia gravis in Department of Cardiothoracic Surgery, Huashan Hospital affiliated to Fudan University between January 2014 and July 2016 were studied. Subxiphoid approach video-assisted thoracoscopic thymectomy (SXVT) and through traditional unilateral approach video-assisted thymectomy (TVAT) were compared. The clinical outcomes of SXVT and TVAT were compared. Results There was no surgical death and no statistical difference between the two groups in drainage time, postoperative volume of drainage, postoperative hospital stay and bleeding volume during operation (P>0.05). However, the acute chest pain after surgery, as well as the postoperative chest pain, and operative time were less in the the SXVT group than that in the TVAT group (P<0.05). Conclusion SXVT for myasthenia gravis is safe and executable. It can alleviate intercostal neuralgia and abnormal chest wall feeling. And it should be considered in the treatment of myasthenia gravis.
Objective To investigate the short-term postoperative pain between robot-assisted and thoracolaparoscopic McKeown esophagectomy for esophageal carcinoma. Methods We prospectively analyzed clinical data of 77 patients with esophageal carcinoma in our hospital between September 2016 and February 2017. The patients were allocated into two groups including a robot group and a thoracolaparoscopic group. The patients underwent robot assisted McKeown esophagectomy in the robot group and thoracolaparoscopic McKeown esophagectomy in the thoracolaparoscopic group. There were 38 patients with 30 males and 8 females at average age of 60.80±6.20 years in the thoracolaparoscopic group, and 39 patients with 35 males and 4 females at average age of 60.90±7.20 years in the robot group. Results There was no statistical difference between the two groups in terms of the postoperative usage of analgesic drugs. The patients in the robot group experienced less postoperative pain on postoperative day 1, 3, 5, 6 and 7 than the patients in the thoracolaparoscopic group. The mean value of visual analogue scale (VAS) on postoperative day 1, 3, 5, 6 and 7 for the robot group and the thoracolaparoscopic group was 3.20±1.10 versus 2.70±0.90 (P=0.002), 2.75±0.96 versus 2.40±0.98 (P=0.030), 2.68±1.08 versus 2.02±0.8 (P=0.005); 2.49±0.99 versus 1.81±0.88 (P=0.003), 2.27±0.83 versus 1.51±0.61 (P<0.001), respectively. Conclusion Compared with the thoracolaparoscopic group, patients receiving robot assisted McKeown esophagectomy experience less postoperative short-term pain. However, the long-term postoperative pain for these patients needs to be further studied.
Objective To compare the differences between the up-lobectomy by single-microport assisted micro-uni-port thoracoscopy surgery and traditional uni-portal video assisted thoracic surgery, summarize and analyze the technical points of single-microport assisted micro-uni-port thoracoscopy surgery, and explore the surgical effect and value of promotion. Methods We retrospectively analyzed the clinical data of patients who underwent radical upper lobectomy at the Thoracic Surgery Department of Xi’an International Medical Center Hospital from March 2023 to June 2024. The patients were divided into two groups according the surgical procedure: a single-micromini-assisted group (patients underwent up-lobectomy by single-microport assisted micro-uni-port thoracoscopy) and a traditional uniportal group (patients underwent traditional uniportal thoracoscopic lobectomy). Clinical outcomes were compared between the two groups. Results We finally included 62 patients. There were 30 patients with 16 males and 14 females at an average of 57.4±10.8 years in the the single-micromini-assisted group and 32 patients with 20 males and 12 females at an average age of 57.6±8.7 years in the traditional uni-port thoracoscopy group. Both groups successfully completed minimally invasive surgery.The baseline data were consistent between the two groups. The operation time was shorter in the single microport assisted group [(146.03±30.79) min vs. (171.41±36.41) min, P=0.004] than that in the traditional uni-port thoracoscopy group with a statistical difference. There was no statistical difference between the two groups in terms of intraoperative blood loss, postoperative pain score, dissected lymph node number, postoperative drainage volume, postoperative tube time, postoperative hospital stay, hospitalization cost, or the incidence of postoperative complications (P>0.05). Conclusion Single-microport assisted micro-uni-port thoracoscopy surgery can maximize the advantages of three-portal and uni-portal VATS, and effectively avoid the disadvantages of three-portal and uni-portal VATS, which can significantly shorten the operation time, without increasing the postoperative pain and complications, is a more minimally invasive, safer and more convenient surgical method.