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。
ObjectiveTo discuss the advantage and disadvantage of uniport video-assisted thoracic surgery (VATS) versus single utility port VATS in the surgical treatment of benign thoracic diseases. MethodsFrom January 2012 to December 2014, 125 patients with benign thoracic diseases who underwent VATS by the same performer were divided randomly into two groups including a uniport VATS group or a single utility port VATS group. There were 41 males and 24 females with a mean age of 47.5±16.6 years in the uniport VATS group. There were 39 males and 21 females with a mean age of 45.1±15.7 years in the single utility port VATS group. Then the patients were followed up. The perioperative data and follow-up results were compared between two groups. ResultsThe total 125 patients of operations were performed successfully according the established plan, without increasing incisions or transferring to thoracotomy. There were no statistical differences between two groups in operative time (48.9±11.3 min vs. 47.1±11.0 min), intraoperative bleeding volume (26.9±15.4 ml vs. 23.8±13.2 ml), postoperative 24 h chest tube drainage volume (81.5±36.9 ml vs. 77.3±31.2 ml), postoperative chest tube drainage time (2.8±2.0 d vs. 3.4±2.2 d), the pain score on the 3rd postoperative day (2.6±1.2 points vs. 2.6±1.3 points), average in-hospital stay (4.9±2.1 d vs. 5.1±2.2 d) or postoperative complications (P > 0.05). The patients were followed up for 3-24 months. All patients achieved satisfactory results with no recurrence. ConclusionsCompared with single utility port VATS, uniport VATS does not prolong operation time or consume more materials, and has advantages of minimally invasion and higher acceptance. It is a safe and feasible approach in surgical treatment of benign thoracic diseases and worthy of popularization and application.
Abstract： Objective To evaluate the safety and efficacy of total thoracoscopic anatomic pulmonary segmentectomy for the treatment of early-stage peripheral lung carcinoma, pulmonary metastases and benign pulmonary diseases. Methods We retrospectively analyzed 20 patients who received total thoracoscopic anatomic pulmonary segmentectomy in Zhongshan Hospital of Fudan University from March 2008 to November 2011. There were ten male and ten female patients with a mean age of 58.0（14-86）years. Three ports were used. The pulmonary artery and vein of the segment were dealt with Hem-o-lok or stapler. The bronchi of the segment were dealt with staplers. Staplers were used in peripheral lung of intersegmental plane. Results All the twenty patients underwent total thoracoscopic anatomic segmentectomy successfully without any conversion to thoracoctomy or lobectomy. No perioperative morbidity or mortality occurred. Postoperative pathological examinations showed lung cancer in 10 patients, pulmonary metastases in 3 patients and benign pulmonary diseases in 7 patients. The mean operative time was 133.0（90-240）min. The mean blood loss was 85.0（50-200）ml. The chest tubes were maintained in position for 3.2 （2-7） d. The mean postoperative hospitalization time was 6.7 （4-11）d. Conclusion Total thoracoscopic anatomic pulmonary segmentectomy is a feasible and safe technique to be used selectively for Ⅰa stage lung cancer, pulmonary metastases and benign pulmonary diseases that are not appropriate for wedge resection.
ObjectiveTo investigate the value of single incision laparoscopic cholecystectomy in the operation of benign diseases of the gallbladder in day surgery.MethodThe clinical data of 105 patients underwent the single incision laparoscopic cholecystectomy in the Day Operation Center of Zhengzhou Central Hospital of Zhengzhou University from March 2017 to December 2018 were retrospectively analyzed.ResultsThe single incision laparoscopic cholecystectomies were successfully performed in 105 patients with benign gallbladder diseases, including 65 cases of gallbladder stones, 26 cases of gallbladder polyps, 14 cases of gallbladder adenomyosis; 45 cases of men and 60 cases of women. In all cases, no incision was increased or no case was converted to laparotomy. No bile duct injury and intra-abdominal bleeding happened during the operation. All patients were discharged overnight (no more than 24 h) after the surgery and without delayed discharge and re-admission. The intraoperative blood loss was (10.3±3.5) mL, and the operation time was (55.0±25.5) min (from laparoscopy to gallbladder removal). The postoperative pain score was 1–2 and 0–1 on day 1 and on day 3 after the surgery, respectively. The postoperative incision cosmetic satisfaction score on month 6 after the operation was 4.5±0.5.ConclusionSingle incision laparoscopic cholecystectomy is safe and feasible for benign gallbladder disease during day surgery.
ObjectiveTo discuss the causes of esophageal benign diseases and how to prevent, diagnose and treat such diseases. MethodsWe reviewed and analyzed the clinical data of 162 patients with esophageal benign diseases treated in our hospital from March 1994 to July 2011. Causes, diagnosis, treatment and prognosis of this kind of diseases were analyzed and summarized. ResultsEighty-five patients had definite inducements. All patients were diagnosed through barium swallow radiography, CT, and gastroscopic inspection and underwent operation. A total of 155 patients were cured by positive treatment, but 7 patients died because of severe infection. ConclusionMost patients suffering from esophageal benign diseases have definite inducements. Therefore, many such diseases can be prevented. Once being confirmed, active surgery is the main treatment. Most patients can be cured if treatment is performed in time.
ObjectiveTo explore the advantages and disadvantages of duodenum-preserving pancreatic head resection (DPPHR) in the clinical application of pancreatic surgical diseases, and to summarize the progress of minimally invasive application of DPPHR combined with the current application of laparoscopy and robot surgery in pancreatic surgery. MethodThe related research literatures about DPPHR at home and abroad in recent years were searched and reviewed. ResultsThe effect of DPPHR compared with traditional pancreaticoduodenectomy (PD) for treatment of benign pancreatic diseases was still controversial, and the postoperative remission effect, perioperative period, occurrence of long-term complications and improvement of quality of life were not very advantageous compared with PD, and the prognosis of minimally invasive surgery was poor. ConclusionDPPHR remains highly controversial for surgical intervention in benign pancreatic disease and has enormous scope for advances in minimally invasive surgical applications in pancreatic surgery, but more clinical studies are needed to verify its clinical efficacy.
目的 初步探討容易誤診為乳腺癌的乳腺良性疾病的病理類型和臨床特征，提高診斷準確率。方法 回顧性分析了1998年9月至2000年1月收治的50例術前診斷為乳腺癌的乳腺良性疾病。 結果 乳腺炎性疾病、纖維囊性增生或／和積乳囊腫、纖維腺病或／和某些纖維腺瘤均易誤診為乳腺癌；此類乳腺良性疾病捫診的準確性顯著低于乳腺鉬靶攝片和彩超檢查(P＜0.005)。 結論 乳腺良性疾病臨床診斷的準確性有賴于病史、乳腺捫診及乳腺X線攝片和彩超的綜合分析。
目的探索單操作孔電視胸腔鏡手術治療胸部良性疾病的有效性和安全性。 方法回顧性分析2008年3月至2013年4月德陽市人民醫院單操作孔電視胸腔鏡手術治療胸部良性疾病186例患者的臨床資料，其中男101例、女85例，年齡15～65（30.1±5.3）歲。 結果全組患者無圍手術期死亡。手術時間18～88（47.2±7.6）min，術中出血量5.0～110.0（49.8±9.4）ml，患者術后住院時間7～16（9.2±2.1）d。2例因致密粘連轉為輔助小切口手術。自發性氣胸肺大泡切除術后當日及術后1～2 d出現持續肺漏氣3例，1例肺漏氣持續9 d，1例肺漏氣持續10 d，1例肺漏氣持續11 d，均經保守治療治愈。切口脂肪液化4例，換藥后治愈。術后肺部感染3例，經加強抗感染后治愈。隨訪3～24（6.8±3.2）個月，失訪18例，總體隨訪率90.3%（168/186）。隨訪期間氣胸復發4例，氣胸壓縮肺組織10%～20%，觀察5～8 d自行吸收，未再次手術；肺及縱隔良性病變無復發；結核患者術后抗癆治療12～18個月治愈。 結論單操作孔電視胸腔鏡手術治療胸部良性疾病創傷小，切口美觀，患者恢復快，手術安全，對適應證患者可作為手術方式。