Objective To investigate the perioperative outcome of robot-assisted pulmonary lobectomy in treating pathological stage Ⅰ non-small cell lung cancer (NSCLC). Methods We retrospectively analyzed the clinical data of 333 consecutive p-T1 NSCLC patients who underwent robotic-assisted pulmonary lobectomy in our hospital between May 2013 and April 2016. There were 231 females (69.4%) and 102 males (30.6%) aged from 20–76 (55.01±10.46) years. Cancer was located in the left upper lobectomy in 37 (11.1%) patients, left lower lobectomy in 71 (21.3%) patients, right upper lobectomy in 105 (31.5%) patients, right middle lobectomy in 32 (9.6%) patients, right lower lobectomy in 88 (26.4%) patients. Adenocarcinoma was confirmed in 330 (99.1%) patients and squamous cell cancer was confirmed in 3 (0.9%) patients. Results Total operative time was 46–300 (91.51±30.80) min. Estimated intraoperative blood loss was 0–100 ml in 319 patients (95.8%), 101–400 ml in 12 patients (3.6%), >400 ml in 2 patients (0.6%). Four patients were converted to thoracotomy, including 2 patients due to pulmonary artery branch bleeding and 2 due to pleural adhesion.No patient died within 30 days after surgery. And no perioperative blood transfusion occurred. Postoperative day 1 drain was 0–960 (231.39±141.87) ml. Chest drain time was 2–12 (3.96±1.52) d.And no patient was discharged with chest tube. Length of hospital stay after surgery was 2–12 (4.96±1.51) d. Persistent air leak was in 12 patients over 7 days. No readmission happened within 30 days. All patients underwent lymph node sampling or dissection with 2–9 (5.69±1.46) groups and 3–21 (9.80±3.43) lymph nodes harvested. Total intraoperative cost was 60 389.66–134 401.65 (93 809.23±13 371.26) yuan. Conclusion Robot-assisted pulmonary lobectomy is safe and effective in treating p-Stage Ⅰ NSCLC, and could be an important supplement to conventional VATS. Regarding to cost, it is relatively more expensive compared with conventional VATS. RATS will be widely used and make a great change in pulmonary surgery with the progressive development of surgical robot.
Objective To investigate the changes and roles of myocardial adenosine triphosphate enzyme(ATPase) in the mechanism of cardiac dysfunction after blunt chest trauma（BCT）. Methods Thirtysix rabbits were divided into 6 groups with random number table, control group, 2 h group, 4 h group, 8 h group, 12 h group and 24 h group, 6 in each group. The models of BCT were established with BIMⅡ biological impact machine, catheterization technique was used through the right jugular artery into the left ventricle measure its pressure. The hemodynamics and the activities of ATPase in myocardial cell plasm, homogenate and mitochondria were measured at preinjury(control group), 2 h, 4 h, 8 h, 12 h and 24 h postinjury. Results Left ventricular endsystolic pressure(LVESP), the maximal ascending rate of left intraventricular pressure(+dp/dtmax), isovolemec pressure(IP) and the maximal physiological velocity(Vpm) decreased significantly at 2 h group after BCT(Plt;0.05）, and recovered to preinjury level in 4 h, 8 h and 12 h group during 4-12 h after BCT; isovolumic relaxation phase left ventricular pressure descending time constant (T). Left ventricular enddiastolic pressure(LVEDP) and the maximal descending rate of left intraventricular pressure(-dp/dtmax) were significantly higher （Plt;0.05, 0.01）. The activity of ATPase in homogenate, mitochondria and cell plasm decreased significantly at 2 h group and 4 h group after BCT（Plt;0.05, 001, respectively）, and 8 h group and 12 h group recovered after BCT. There was negative correlations between [CM(159mm]LVEDP and -dp/dtmax and the decrease of the activity of Na+-K+-ATPase in homogenate（r=-0.674, -0.691, Plt;0.05）, the Ca2+-ATPase in homogenate（r=-0.613,-0.642, Plt;0.05）, the Na+-K+-ATPase in mitochondria（r=-0.622,-0.616, Plt;0.05）,the Ca2+-ATPase in myocardial cell plasm（r=-0.672,-0.658, Plt;0.05）, the Na+-K+-ATPase in myocardial cell plasm（r=-0.627,-0.632,Plt;0.05）,and the Mg2+-ATPase in myocardial cell plasm（r=-0.677,-0.661, Plt;0.05）. Conclusion The left ventricular function is impaired obviously after BCT, especially in diastolic phase. The decrease of the activity of ATPase in myocardial cells may be one of the reasons of cardiac dysfunction after BCT.
Objective To explore current view and application status of video-assisted thoracoscopic surgery （VATS） of thoracic surgeons in some municipal hospitals in China，and provide evidence for further VATS study and training.Methods We conducted a questionnaire study for thoracic surgeons in municipal hospitals who attended the 5th West China Forum on Mini-invasive Thoracic Surgery in 2012. The questionnaire content included general descriptions of the thoracic surgeons，the departments of thoracic surgery where they worked，and VATS application status in their hospitals. A total of 263 surgeons were investigated，and 183 （69.58%） valid questionnaires were collected for descriptive analysis.Results （1） Responders’ view of VATS：There were 89.62% （164/183） responders who believed that the advantages of VATS were mainly mini-invasive and fast postoperative recovery，while its disadvantage was high cost （76.50%，140/183）. There were 71.04% （130/183） responders who thought that VATS lobectomy could provide a higher postoperative quality of life for lung cancer patients，while only 12.57% （23/183） responders thought that the 5-year survival rate of VATS was higher than that of open thoracotomy. There were 60.11% （110/183） responders who believed that VATS was less widely performed in China than America，but VATS level of very few hospitals in China was superior or equal to American level. There were 52.46% （96/183） responders who agreed that VATS could be used for the treatment of locally advanced lung cancer. （2） Training situation of VATS lobectomy for lung cancer：Learning class or short-term training （32.24%，59/183） was the best way to learn VATS lobectomy. Their main learning process was from open thoracotomy to mini- thoracotomy then to VATS （60.66%，111/183）. Single-direction thoracoscopic lobectomy was the most popular VATS technique （54.64%，100/183），and its learning curve was at least 30 cases （26.78%，49/183）. （3） VATS application status：VATS was performed in all the hospitals investigated. Benign thoracic diseases were most commonly chosen by thoracic surgeons who started to perform VATS （81.42%，149/183）. The main initial hurdles of VATS lobectomy for lung cancer included poor operation theater conditions and surgical teamwork （39.34%，72/183） as well as unsatisfactory surgical techniques （36.07%，66/183）. Further improvement of VATS technique （118/183，64.48%） was the developmental trend of VATS. Conclusions Thoracic surgeons in China have reached the consensus on the application of VATS for surgical treatment of thoracic diseases including lung cancer. Single-direction thoracoscopic lobectomy is a widely accepted technique. Further trends of VATS training and development are equipment upgrade and better teamwork.
目的 探討電視胸腔鏡手術（VATS）在胸部刀刺傷中的應用價值。 方法 回顧性分析我院 2012～2015 年 22 例胸部刀刺傷行 VATS 診治的臨床資料。其中男 20 例、女 2 例，年齡 26.5（17～48）歲。 結果 行 VATS 18 例，肺破裂修補 12 例，出血血管鈦夾、電凝止血 4 例，肺破裂及膈肌破裂修補 2 例；輔助小切口手術 2 例，肋間動脈縫扎止血 1 例，膈肌修補 1 例；中轉開胸行心室壁修補術 1 例，胸腔鏡下膈肌破裂修補合并開腹行肝破裂修補術 1 例。全組無手術死亡，無術后嚴重并發癥。 結論 VATS 安全、有效、創傷小，早期應用有助于降低胸部刀刺傷患者的死亡風險。
目的 介紹胸部良性疾病經單孔胸腔鏡切除術后免胸腔引流管的臨床經驗。 方法 回顧性分析 2015 年 10 月至 2016 年 10 月我院胸外科 17 例行單孔胸腔鏡手術患者的臨床資料，其中男 9 例、女 8 例，年齡 33.8（17～58）歲。行肺大皰切除術 7 例，肺楔形切除術 9 例，交感神經烙斷術 1 例。 結果 所有患者均經單孔胸腔鏡手術有效切除，期間無中轉開胸或再次開操作孔，術后不放置胸腔引流管，手術時間為（60.3±8.2）min，術中出血量為（15.2±5.1）ml，術后第 1 d、2 d、3 d 疼痛視覺模擬評分（VAS） 為 6.5±2.2，5.8±2.1，3.5±1.3，術后舒適度評分分別為 8.6±1.3，術后早期下床活動時間為（1.0±0.3）d，切口甲級愈合率 100.0%。17 例患者均無心律失常、肺部感染等并發癥，術后隨訪 6 個月氣胸均無復發。 結論 合理選擇及嚴格基線評估，胸部良性疾病經單孔胸腔鏡切除術后免胸腔引流管是安全可行的，可能有利于患者術后快速康復。
Abstract： Objective To investigate the effect of preoperative oral carbohydrate （CHO） administration on perioperative risks of patients with surgical thoracic oncology，and provide evidence for establishing new scientific preoperative fasting strategy.Methods?In this prospective study， from July to September 2010，32 out of 65 enrolled patients with surgical thoracic oncology in Department 1 of Thoracic Surgery，Cancer Hospital of Peking University， were randomly allocated to preoperative experiment group （fasting overnight and oral 12.5% dextrose 400 ml administration 2 h before anesthesia induction） or control group （fasting overnight and water deprivation from midnight）. Clinical data were collected including subjective evaluation of thirst and hunger measured by visual analogue scale （VAS）， blood glucose level（BGL），serum insulin level， homeostasis model assessment insulin resistance（HOMA-IR），postoperative length of hospital stay （LOS） and complications.Results?Sixteen patients were enrolled in each group. VAS scores of thirst and hunger of the preoperative experiment group at 1 h before anesthesia induction were significantly lower than those of the control group（24 vs. 49，24 vs. 62 ，P=0.000）. BGL（8.59±0.43 mmol/L vs. 5.59±0.43 mmol/L， P=0.000）， serum insulin level （24.33±1.80 mIU/ ml vs. 16.28±1.80 mIU/ml， P=0.004）and HOMA-IR（9.23±0.77 vs. 4.03±0.77，P=0.000）of the preoperative experiment group before anesthesia induction were significantly higher than those of the control group，and these three variables of the preoperative experiment group returned to baseline level soon after surgery. There was no statistical difference in postoperative LOS and complication rate between the two groups （P＞0.05）.Conclusion?Preoperative oral CHO treatment is safe for non-diabetic patients with surgical thoracic oncology， can alleviate their subjective discomfort，decrease insulin resistance， and ameliorate their perioperative stress and metabolism.
ObjectiveBy combining biological detection and imaging evaluation, a clinical prediction model is constructed based on a large cohort to improve the accuracy of distinguishing between benign and malignant pulmonary nodules. MethodsA retrospective analysis was conducted on the clinical data of the 32 627 patients with pulmonary nodules who underwent chest CT and testing for 7 types of lung cancer-related serum autoantibodies (7-AABs) at our hospital from January 2020 to April 2024. The univariate and multivariate logistic regression models were performed to screen independent risk factors for benign and malignant pulmonary nodules, based on which a nomogram model was established. The performance of the model was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). ResultsA total of 1 017 patients with pulmonary nodules were included in the study. The training set consisted of 712 patients, including 291 males and 421 females, with a mean age of (58±12) years. The validation set included 305 patients, comprising 129 males and 176 females, with a mean age of (58±13) years. Univariate ROC curve analysis indicated that the combination of CT and 7-AABs testing achieved the highest area under the curve (AUC) value (0.794), surpassing the diagnostic efficacy of CT alone (AUC=0.667) or 7-AABs alone (AUC=0.514). Multivariate logistic regression analysis showed that radiological nodule diameter, nodule nature, and CT combined with 7-AABs detection were independent predictors, which were used to construct a nomogram prediction model. The AUC values for this model were 0.826 and 0.862 in the training and validation sets, respectively, demonstrating excellent performance in DCA. ConclusionThe combination of 7-AABs with CT significantly enhances the accuracy of distinguishing between benign and malignant pulmonary nodules. The developed predictive model provides strong support for clinical decision-making and contributes to achieving precise diagnosis and treatment of pulmonary nodules.