Objective To investigate the safety of thoracic surgery for high-altitude patients in local medical center. MethodsWe retrospectively collected 258 high-altitude patients who received thoracic surgery in West China Hospital, Sichuan University (plain medical center, 54 patients) and People's Hospital of Ganzi Tibetan Autonomous Prefecture (high-altitude medical center, 204 patients) from January 2013 to July 2019. There were 175 males and 83 females with an average age of 43.0±16.8 years. Perioperative indicators, postoperative complications and related risk factors of patients were analyzed. ResultsThe rate of minimally invasive surgery in the high-altitude medical center was statistically lower than that in the plain medical center (11.8% vs. 55.6%, P<0.001). The surgical proportions of tuberculous empyema (41.2% vs. 1.9%, P<0.001) and pulmonary hydatid (15.2% vs. 0.0%, P=0.002) in the high-altitude medical center were statistically higher than those in the plain medical center. There was no statistical difference in perioperative mortality (0.5% vs. 1.9%, P=0.379) or complication rate within 30 days after operation (7.4% vs. 11.1%, P=0.402) between the high-altitude center and the plain medical center. Univariate and multivariate analyses showed that body mass index≥25 kg/m2 (OR=8.647, P<0.001) and esophageal rupture/perforation were independent risk factors for the occurrence of postoperative complications (OR=15.720, P<0.001). ConclusionThoracic surgery in the high-altitude medical center is safe and feasible.
This paper systematically summarizes the practical experience of the 2025 Dingri earthquake emergency medical rescue in Tibet. It analyzes the requirements for earthquake medical rescue under conditions of high-altitude hypoxia, low temperature, and low air pressure. The paper provides a detailed discussion on the strategic layout of earthquake medical rescue at the national level, local government level, and through social participation. It covers the construction of rescue organizational systems, technical systems, material support systems, and information systems. The importance of building rescue teams is emphasized. In high-altitude and cold conditions, rapid response, scientific decision-making, and multi-party collaboration are identified as key elements to enhance rescue efficiency. By optimizing rescue organizational structures, strengthening the development of new equipment, and promoting telemedicine technologies, the precision and effectiveness of medical rescue can be significantly improved, providing important references for future similar disaster rescues.
Objective To evaluate the safety and efficacy of day surgery laparoscopic transabdominal preperitoneal repair (TAPP) in high-altitude areas. Methods The clinical data of TAPP patients admitted to the Department of Hernia Surgery, Qinghai Red Cross Hospital between January 2022 and December 2024 were retrospectively analyzed. The patients were divided into the day surgery group and the inpatient group according to the surgical method. Logistic regression was used to calculate propensity score, incorporating variables such as sex, age, ethnicity, body mass index, hernia side, hernia type, and hernia classification. Matching samples were obtained by nearest neighbor 1∶1 without replacement matching, and hospital stay, total hospitalization costs, and postoperative complications were compared. Results A total of 388 patients were included. Among them, there were 342 males and 46 females; the average age was (48.48±16.08) years. A total of 98 matching samples were obtained. In the matched 98 pairs of samples, compared with the conventional group, the day surgery group had a shorter length of stay [1.0 (1.0, 1.0) d vs. 5.0 (4.0, 7.0) d, P<0.001] and a lower total cost [9 335.6 (8 332.9, 10 709.8) vs. 1 1130.7 (959.9, 12 286.9) yuan, P＜0.001]. There was no statistically significant difference in the incidence of early postoperative pain score, postoperative delayed wound healing / infection, postoperative chronic pain, postoperative seroma, and unplanned return visits between the two groups (P>0.05). Conclusions Day-surgery TAPP repair for inguinal hernia appears safe and effective in a high-altitude region, with the added benefits of reduced hospital stay and lower costs. This approach may be considered for wider clinical implementation.
ObjectiveTo evaluate the clinical efficacy and safety of a perioperative lung protective protocol specifically adapted for minimally invasive esophagectomy (MIE) in high-altitude hypoxic environments, thereby providing evidence-based guidelines for MIE in high-altitude regions. MethodsThis retrospective study analyzed the clinical data of 69 patients (a study group) who underwent combined thoracoscopic and laparoscopic esophagectomy with a high-altitude-specific lung protective strategy at Qinghai Provincial People’s Hospital from March 2022 to November 2024. A historical control group comprised 67 patients (control group) who underwent the same surgery without this protocol from March 2020 to February 2022. Propensity score matching was employed to balance baseline covariates. The study group received a comprehensive lung protective protocol encompassing preoperative pulmonary function assessment and optimization, individualized lung protective ventilation and meticulous anesthesia management during surgery, and standardized enhanced recovery after surgery. Primary outcome measures included surgical duration, intraoperative blood loss, oxygenation index during one-lung ventilation, incidence of postoperative complications, pulmonary function recovery trajectory, and long-term disease-free survival. ResultsAfter propensity score matching, 58 patients [44 males, 14 females; mean age (62.3±8.5) years] were included in the study group, and 55 patients [41 males, 14 females; mean age (61.8±9.2) years] in the control group. Surgical duration was significantly shorter in the study group [ (289.7±26.1) min vs. (312.6±30.3) min, P<0.001], and intraoperative blood loss was significantly lower [ (187.0±12.6) mL vs. (215.4±18.5) mL, P<0.001]. During one-lung ventilation, the PaO2/FiO2 ratio was significantly higher in the study group [ (285.6±45.2) mm Hg] compared to the control group [ (210.3±39.7) mm Hg, P<0.001]. The incidence of overall postoperative complications (15.5% vs. 32.7%, P=0.031) and pulmonary complications (6.9% vs. 21.8%, P=0.012) was significantly lower in the study group. At 7 days postoperatively, forced vital capacity and forced expiratory volume in 1 second recovered to 85.6% and 83.2% of preoperative levels, respectively, and approached preoperative levels by 6 months. The 12-month disease-free survival rate was 91.4% in the study group, which was superior to 83.6% in the control group (log-rank χ2=4.521, P=0.033). ConclusionThe perioperative lung protective protocol, specifically designed for high-altitude hypoxic environments, is safe and effective. It significantly improves intraoperative oxygenation, reduces postoperative complications, accelerates pulmonary function recovery, and does not compromise oncological radicality. This protocol offers a standardized practice guideline for minimally invasive esophagectomy in regions with altitudes ranging from 2 260 to 3 200 meters.