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@#Objective To summarize the clinical experience of thoracoscopic combined subsegmentectomy (CSS). Methods The clinical data of 76 patients who underwent thoracoscopic CSS in Anqing Municipal Hospital from May 2018 to July 2022 were retrospectively analyzed, including 22 males and 54 females, aged 27.0-76.0 (54.3±10.5) years. All patients underwent preoperative three-dimensional computed tomography bronchography and angiography using dual source CT. The modified inflation-deflation technique or indocyanine green was used to identify the intersubsegmental border. Results A total of 86 pulmonary nodules were resected in 76 patients. One patient of left upper lobe S1+2c+S4a, 1 patient of right upper lobe S2b+S3a and 1 patient of right upper lobe S1b+S3b were further performed lobectomy due to insufficient margin. One patient of left upper lobe S1+2+S3a was further performed left upper division segmentectomy due to residual atelectasis. One patient of left upper lobe S1+2c+S3a was further performed left upper division segmentectomy due to B3b+c injury, and the rest completed planned surgeries successfully. The operative time was 90.0-350.0 (174.9±53.2) min. The operative hemorrhage volume was 50.0 (20.0, 50.0) mL. The postoperative hospital stay time was 6.0 (5.0, 7.0) d. Postoperative complications included pulmonary infection in 9 patients, hemoptysis in 3 patients, persistent pulmonary leakage>3 d in 4 patients, pneumothorax in 1 patient, pleural effusion in 1 patient, and myocardial infarction in 1 patient. All of the patients were cured and discharged without perioperative death. Conclusion Thoracoscopic CSS is relatively complex. Preoperative planning under three-dimensional reconstruction and intraoperative fine operation are helpful for safe completion.
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@#Objective To evaluate the efficacy of thoracoscopic complex segmentectomy for stageⅠnon-small cell lung cancer (NSCLC). Methods We retrospectively reviewed the perioperative clinical data of patients with stageⅠNSCLC who underwent thoracoscopic complex segmentectomy (n=58) or simple segmentectomy (n=33) between January 2017 and March 2020 in our hospital. There were 36 males and 55 females with a median age of 57 years (range: 50-66 years). The clinical data of the two groups were compared. Results There were no significant differences between the two groups in characteristics including age, sex, weight, comorbidities, preoperative pulmonary function, dominant composition of tumor, tumor histology and size, overall complications, estimated blood loss, prolonged air leakage, length of hospital stay, length of drainage, surgical margin distance or number of dissected lymph nodes. Only the operation time and number of staples for making intersegmental plane were significantly different between the two groups (P<0.05). There was no perioperative death in both groups. Conclusion Thoracoscopic complex segmentectomy is a feasible and safe technique for stageⅠNSCLC.
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@#Objective To explore the clinical issues associated with video-assisted pulmonary segmentectomy and to provide reference for better implementation of thoracoscopic pulmonary segmentectomy and reduction of perioperative complications through analyzing the clinical results of thoracoscopic segmentectomy. Methods The clinical data of 90 patients who planned to undergo thoracoscopic segmentectomy in our department from October 2017 to December 2019 were retrospectively analyzed, including 35 males with an average age of 60.34±9.40 years and 55 females with an average age of 56.09±12.11 years. The data including lung nodule number, benign or malignant, preoperative location by Hookwire, preoperative planning and actual implementation, operation time, intraoperative blood loss, postoperative drainage volume and time of drainage tube removal, postoperative hospital stay and complications were collected and analyzed. Results Among the 90 patients, 38 were preoperatively positioned by Hook-wire, 52 were directly operated on; 87 were completed under thoracoscopic surgery among whom 3 underwent passive lobectomy after segmentectomy under thoracoscopic surgery, and 3 were converted to thoracotomy among whom 1 underwent lobectomy. Operation time was 198.58±56.42 min, intraoperative blood loss was 129.78±67.51 mL, lymph node samples were 6.43±1.41, drainage time was 2.98±1.25 d, the amount of postoperation drainage was 480.00±262.00 mL, hospital stay was 7.60±2.38 d. In all patients, 73 had single nodules and 17 had multiple nodules. Totally 113 pulmonary nodules were resected, 14 (12.39%) were benign nodules and 99 (87.61%) were malignant nodules. There was no perioperative death or serious complications. Conclusion For those pulmonary parenchymal nodules which meet the indications, it is feasible to perform thoracoscopic anatomic pulmonary segmentectomy according to preoperative thin-slice CT and three-dimensional computed tomography-bronchography and angiography (3D-CTBA) reconstruction results. Preoperative Hookwire localization can ensure effective edge resection and reduce unplanned lobotomy for intersegmental nodules and non-palpable peripheral pure ground-glass nodules.
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Objective Comparative study on efficacy and complications between totally laparo-thoracoscopic Ivor-Lewis esophagectomy(LTILE)combined with jejunostomy,and esophagectomy with assisted abdominal incision.Methods Clinical data of 160 patients with mid-lower thoracic esophageal cancer who underwent thoracoscopic laparoscopic oesophagectomy within the same therapeutic group from January 2017 to July 2018 were retrospectively analyzed.79 patients underwent totally LTILE combined with jejunostomy;the rest 81 patients had LTILE with assisted abdominal incision and nasointestinal tube placement.Preoperative,intraoperative and postoperative clinical data and complicatioos were analyzed.Results There was no significant difference between two groups,including operation time,intraoperative blood loss,number of lymph nodes dissection,postoperative drainage and total treatment cost.In terms of the postoperative pain scores within 3 days,incision complications,pulmonary infection rate and postoperative hospitalization time,there were significant differences(P ＜ 0.05).Conclusion Complete LTILE with jejunostomy appeared to render better short-term clinical outcomes.
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Objective To evaluate the clinical application of CT-guided localization with combination of methylene blue and a Hookwire system for small pulmonary nodules (SPNs) before video-assisted thoracoscopic resection.Methods CTguided localization the SPNs before resection in 56 patients and 60 nodules,then underwent video-assisted thoracic surgery (VATS) resection.Among 56 patients,19 males and 37 females,aged from 35 to 81 years,mean age was (61.1 ±8.9)years.Results SPNs diameter (6.80 ±4.12) mm,distance from the parietal pleura (15.38 ±4.63) mm.CT-guided localization success rate was 100％,positioning time (10.76 ± 8.17) min,8.9％ (5/56) had micro pneumothorax aftet positioning,7.1％ (4/56) occurrence of needle tract bleeding,no conservative treatment.VATS resection rate was 100％.The pathology of 60 lesions were shown:Bronchiolo-alveolar carcinoma(BAC) were 33 lesions(55.0％),BAC and adenocarcinoma were 11 lesions(18.3％),Atypicaladenomatous hyperplasia (AAH) were 7 lesions (11.8％),Inflammation were 4 lesions (6.7％),Harmatoma were 3 lesions(5.0％),Tuberculoses were 2 lesions(3.3％).Conclusion CT-guided localization with combination of methylene blue and a Hookwire system before video-assisted thoracoscopic resection is a promising technique for small solitary pulmonary nodules.It could play an important role in accurate localization of small pulmonary nodules,and it is a safe technique with clinical application.