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.
Objective To analyze the safety and effectiveness of ultrasound-guided thoracoscopic atrial septal defect (ASD) closure. Methods We prospectively collected the clinical data of 12 patients with ASD treated by ultrasound-guided thoracoscopic ASD closure in Fuwai Hospital from January to September 2017. The characteristics of the patients' ASD and operation, operation safety and effectiveness, postoperative complications and follow-up results were analyzed. Results Among the 12 patients, 10 were successfully treated with ultrasound-guided thoracoscopic ASD closure. Two patients switched to ASD repair under thoracoscopy-assisted cardiopulmonary bypass. The size of the ASD was 17-40 (27.22±8.97) mm and the size of the occluder was 36 (30-42) mm. The average postoperative length of hospital stay was 6 days. There were no complications such as arrhythmia, bleeding and pericardial effusion after operation. The average follow-up was 6 (3-10) months after the operation. During the follow-up, no Ⅲ-degree conduction block, occluder dislocation, residual shunt or cardiac pericardial effusion was found. Conclusion Ultrasound-guided thoracoscopic ASD closure is a minimally invasive, safe and effective treatment. This technique provides a new minimally invasive surgical option for patients with large defect diameter and poor edge condition.
ObjectiveTo compare the clinical efficacy of video-assisted thoracoscopy and thoracotomy for the treatment of encapsulated tuberculous pleurisy. MethodsWe retrospectively analyzed the clinical data of 99 patients who had underwent surgery for encapsulated tuberculous pleurisy within 3 months of disease onset in our hospital from January through December 2013. Based on the surgical mode, patients were assigned to a video-assisted thoracoscopy group, including 49 patients (35 males and 14 females, a mean age of 26.78±9.36 years), to receive video-assisted thoracoscopic pleurectomy; or a thoracotomy group, including 50 patients (31 males and 19 females, a mean age of 31.84±11.08 years), to receive conventional thoracotomic pleurectomy. The first 43 patients in the video-assisted thoracoscopy group received thoracic catheter drainage, with the drainage volume of 659.08±969.29 ml; the first 48 patients in the thoracotomy group received thoracic catheter drainage, with the drainage volume of 919.03±129.97 ml. The clinical effects were compared between the two groups. ResultsAll the patients in the video-assisted thoracoscopy group completed thoracoscopy without conversion to thoracotomy. The surgery duration and postoperative intubation time were shorter in the video-assisted thoracoscopy group than those in the thoracotomy group (surgery duration:103.00±53.04 min vs. 127.06±51.60 min, P<0.01; postoperative intubation time 3.02±0.83 d vs. 3.94±1.25 d, P<0.01). At the end of 6 months of follow-up, the forced expiratory volume in one second (FEV1>) was 2.83±0.64 L in the thoracos-copy group and 2.25±0.64 L in the thoracotomy group (P<0.01); forced vital capacity (FVC) was 3.02±0.72 L in the thora-coscopy group and 2.57±0.79 L in the thoracotomy group (P<0.05); and maximal voluntary ventilation (MVV) was 93.90± 15.86 L in the thoracoscopy group and 80.34±17.06 L in the thoracotomy group (P<0.01). ConclusionThoracoscopic surgery is feasible for patients with encapsulated pleurisy within 3 months of onset. Furthermore video-assisted thoraco-scopy will be superior to thoracotomy.
ObjectiveTo analyze the effect of 3D simulation technique in thoracoscopic lobectomy.MethodsFrom June 2015 to January 2018, 124 patients with left lower lobe resection underwent thoracoscopy with single-port thoracoscopic surgery, including 64 males and 60 females, aged 42–83 years. They were randomly divided into two groups including an experimental group (preoperatively given 3D simulation surgery in 59 patients) and a control group (preoperatively not given 3D simulation surgery in 65 patients). The clinical effect between the two groups was compared.ResultsAll patients recovered without any death during hospitalization. In the experimental group, the operation time, intraoperative blood loss and postoperative hospital stay were significantly less than those in the control group (P<0.05). There was no significant difference in postoperative drainage volume, and duration of drainage tube retention and analgesic drug usage between the two groups (P>0.05).Conclusion3D simulation technique for thoracoscopic lobectomy has advantage in short operation time, minor trauma and quick recovery. It has a guiding role in the preoperative planning of lung cancer surgery and is worthy of popularization and application.
ObjectiveTo compare the clinical efficacy of endoscopic minimally invasive surgery and median sternotomy thoracotomy in the treatment of atrial myxoma by meta-analysis.MethodsWe searched CBM, CNKI, Wanfang Data, VIP, PubMed, the Cochrane Library and EMbase to collect relevant researches on atrial myxoma and endoscopic minimally invasive surgery. The retrieval time was from the establishment of the database to September 2020. Two reviewers independently screened the literature, extracted data and evaluated the bias risk of included studies by the Newcastle-Ottawa scale (NOS). Then, the meta-analysis was performed by Stata 16.0.ResultsTen articles were included in the study, all of which were case-control studies. The quality of literature was grade B in 5 articles and grade A in 5 articles. The sample size of surgery was 938 patients, including 480 patients in the endoscopic minimally invasive group, 458 patients in the median thoracotomy group, and 595 patients in follow-up. A total of 18 outcome indexes were included in the meta-analysis. The combined results of 9 outcome indicators were statistically significant: cardiopulmonary bypass time (SMD=0.32, 95%CI 0.00 to 0.63, P=0.048); ventilator assisted ventilation time (SMD=?0.35, 95%CI ?0.56 to ?0.15, P=0.001), ICU stay time (SMD=–0.42, 95%CI ?0.62 to ?0.21, P<0.001); postoperative hospitalization time (SMD=?0.91, 95%CI ?1.22 to ?0.60, P<0.001); postoperative drainage volume (SMD=?2.48, 95%CI ?5.24 to 0.28, P<0.001); postoperative new onset atrial fibrillation (OR=0.29, 95%CI 0.12 to 0.67, P= 0.005); postoperative pneumonia (OR=0.09, 95%CI 0.02 to 0.36, P=0.001); postoperative blood transfusion (OR=0.22, 95%CI 0.11 to 0.45, P<0.001); incision satisfaction (OR=83.15, 95%CI 1.24 to 5563.29, P=0.039).ConclusionAvailable evidence suggests that median thoracotomy requires shorter cardiopulmonary bypass time than endoscopic minimally invasive surgery; during the 5-year follow-up after surgery and discharge, ICU stay time, postoperative hospital stay, postoperative drainage, new atrial fibrillation after surgery, postoperative pneumonia, postoperative blood transfusion, satisfactory incision, endoscopic minimally invasive surgery showed better results than median sternotomy thoracotomy.
Abstract: Objective To explore the outcomes of videoassistedthoracoscopic surgery (VATS) in the treatment of esophageal leiomyoma. Me thods [WTBZ] We reviewed and analyzed the clinical data of 87 patients with esophageal leiomyoma treated with VATS in Changhai Hospital of Second Military Medical University between June 2002 and January 2009. [WTHZ]Results [WTBZ]Videoassisted thoracoscopic leiomyoma enucleations was performed in 80 patients, whilea conversion to minithoracotomy was required in 7 others. All procedures werecompleted smoothly and the postoperative recovery was uneventful, without mortality or severe complications. The patients were drinking liquids from postoperative day 1 and were eating a normal diet from day 3. All patients were pathologically diagnosed with leiomyoma after operation. Followups of 6 months to 6.5 years (mean: 3.8 years) found no recurrence. [WTHZ] Conclusion [WTBZ]Videoassisted thoracoscopic enucleation can be the first choice for esophageal leiomyomas derived from lamina propria. Patients with esophageal leiomyomas of diameter gt;1.0 cm should be treated with VATS .
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.
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.
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.
Compensatory hyperhidrosis (CH) is a severe side effect that occurs after endoscopic thoracic sympathotomy (ETS) for the treatment of palmar hyperhidrosis. CH significantly interferes with daily activities such as work, study, and social interactions, leading to a substantial decrease in the quality of life for patients. Preventing and treating CH are currently important and challenging issues in minimally invasive surgery for palmar hyperhidrosis. In this report, we presented a 29-year-old male patient who experienced severe CH for 8 years following ETS. The patient underwent staged unilateral endoscopic expanded sympathotomy (ES) at our hospital on December 11, 2023 and January 3, 2024, targeting the R4-R10 levels. After a 3-month follow-up, the patient experienced significant improvement in clinical symptoms and quality of life, with no recurrence of palmar hyperhidrosis or other complications. The treatment outcome was satisfactory.