ABSTRACT
Objective To investigate the feasibility and superiority of local anaesthesia video-assisted thoracoscopic surgery (LA-VATS) in diagnosis and treatment of open thoracic trauma (OTT).Methods Seventy-eight patients with OTT emergently admitted from February 2007 and June 2012 were randomized into LA-VATS group (n =37) and conventional treatment group (n =41) by the toss of a coin.In the LA-VATS group,further treatment was determined following LA-VATS.Volume of chest tube drainage,duration of chest tube placement,average length of hospital stay,and postoperative complications were measured and compared between groups.Results In the LA-VATS group,23 patients completed LA-VATS and 14 were transferred for simple VATS-assisted mini-thoracotomy under general anesthesia.In the conventional treatment group,24 cases completed debridement and chest drainage and 17 cases were transferred for thoracotomy under general anesthesia.Volume of chest tube drainage [(195.0 ± 150.8) ml/d∶ (480.0 ±212.3)ml/d] (t =-2.675,P ＜0.05),duration of chest tube placement [(2.6 ± 1.4) d∶ (3.8 ± 1.9) d] (t =-2.318,P ＜ 0.05),average length of hospital stay [(6.4 ±2.3) d ∶ (10.9 ± 3.3) d] (t =-2.471,P ＜ 0.05),and incidence rate of postoperative complications (10.8％ ∶22.0％) (x2 =4.132,P ＜0.05) were all significantly different between LA-VATS and conventional treatment groups.Conclusion LA-VATS is safe and feasible for diagnostic exploration and simple treatment of OTT.
ABSTRACT
Purpose:To explore the rational operative approach in patients with carcinoma of the middle third of the esophagus by T and N status as determined by preoperative CT scan. Methods:87 cases with carcinoma of the middle third of the esophagus chosen for the operative approach by CT findings entered the observational group, 118 cases with carcinoma of the middle third of the esophagus who were not scanned by CT were put into the control group. The observational group adopted different operative approaches by the relationship between the primary tumour and the aorta,and the relationship between the primary tumour and the azygos vein,and by the metastasis of regional lymph nodes. The operative approaches were chosen as follows:if the aorta was not involved, the operative approaches were chosen by the metastastatic status of the regional lymph nodes; left thoracoabdominal approaches were chosen,if the aorta was involved,and Ivor-Lewis operation was involved if the azygos vein was involved.The control group adopted the Ivor-Lewis operation. The rate of resection between two groups and the difference in positivity rates of the resected regional lymph node were analysed by chi-square test and T test. Results:Sensitivity of N staging by CT scan was 74.7%(65/87), and specificity of N staging was 60%(39/65). Sensitivity of diagnosis of the aorta involved by tumour by CT scan was 21.8%(19/87), and specificity was (26.3%)(5/19). The rate of resection in the observational group was 92%, and the rate of resection in the control group was'81.4%. Both were markedly different,P