ABSTRACT
@#Objective To study the correlation of preoperative hemoglobin amount with venous thromboembolism (VTE) after surgical treatment of bronchiectasis and the clinical significance. Methods A retrospective study was performed on patients with bronchiectasis who underwent surgical treatment in our center from June 2017 to November 2021. The differences in blood parameters between the VTE patients and non-VTE patients were compared. The relationship between preoperative hemoglobin and VTE was confirmed by quartile grouping and receiver operating characteristic (ROC) curve. Results A total of 122 patients were enrolled, including 50 males and 72 females, with a mean age of 52.52±12.29 years. The overall incidence of VTE after bronchiectasis was 9.02% (11/122). Preoperative hemoglobin amount (OR=0.923, 95%CI 0.870-0.980, P=0.008) and D-dimer amount (OR=1.734, 95%CI 1.087-2.766, P=0.021) were independent influencing factors for VTE after bronchiectasis. The incidence of VTE after bronchiectasis decreased gradually with the increase of preoperative hemoglobin amount. The area under the ROC curve (AUC) of postoperative D-dimer alone was 0.757, whereas the AUC of postoperative D-dimer combined with preoperative hemoglobin amount was 0.878. Conclusion Low preoperative hemoglobin is an independent risk factor for postoperative VTE. Postoperative D-dimer combined with preoperative hemoglobin amount has a better predictive performance compared with postoperative D-dimer alone for postoperative VTE.
ABSTRACT
@#Objective To investigate the surgical procedure selection, operation technique and safety of anatomic sublobar resection for pulmonary nodules. Methods The clinical data of 242 patients with clinical stage ⅠA lung cancer who underwent anatomic sublobar resection in our hospital between 2017 and 2020 were retrospectively analyzed. There were 81 males and 161 females with a median age of 57.0 (50.0, 65.0) years. They were divided into 4 groups according to the surgical methods, including a segmentectomy group (n=148), a combined segmentectomy group (n=31), an enlarged segmentectomy group (n=43) and an anatomic wedge resection group (n=20). The preoperative CT data, operation related indexes and early postoperative outcomes of each group were summarized. Results The median medical history of the patients was 4.0 months. The median maximum diameter of nodule on CT image was 1.1 cm, and the consolidation/tumor ratio (CTR) was ≤0.25 in 81.0% of the patients. A total of 240 patients were primary lung adenocarcinoma. The median operation time was 130.0 min, the median blood loss was 50.0 mL, the median chest drainage time was 3.0 d, and the hospitalization cost was (53.0±12.0) thousand yuan. The operation time of combined segmentectomy was longer than that of the segmentectomy group (P=0.001). The operation time (P=0.000), intraoperative blood loss (P=0.000), lymph nodes dissected (P=0.007) and cost of hospitalization (P=0.000) in the anatomic wedge resection group were shorter or less than those in the other three groups. There was no significant difference in the drainage time, total drainage volume, air leakage or postoperative hospital stay among the four groups (P>0.05). Conclusion The combined application of segmentectomy and wedge resection technique provides a more flexible surgical option for the surgical treatment of early lung cancer with ground glass opacity as the main component.
ABSTRACT
Objective:To investigate the safety and efficacy of anatomic combined pulmonary segmental resection in patients with bronchiectasis.Methods:This study reviewed the data of patients who underwent thoracoscopic combined pulmonary segmentectomy for bronchiectasis in our hospital from January 2015 to June 2019.The surgical indications were a patient diagnosed with bronchiectasis by high-resolution CT(HRCT), radiographic presence of surgical target, clinical symptoms such as repeated infection, hemoptysis or persistent sputum, and poor relief of symptoms under medical treatment.A total of 113 patients with complete data were divided into two groups according to surgical methods: anatomical combined pulmonary segemectomy(anatomical group, 62 cases) and non-anatomical combined pulmonary segemectomy(non-anatomical group, 51 cases). Detection of two groups of patients with general information as well as the operation time, intraoperative blood loss and extubation time, postoperative complications(BPF, continuous leakage, hemoptysis and pulmonary infection, etc.), such as index to evaluate the safety, postoperative 1 year follow-up review, record the change of the two groups of postoperative lung function 1 year, pulmonary infection and the times of reentry haemoptysis symptom control, evaluation of operation effect.Results:The results showed that there were no statistical differences between the two groups in age, gender, lesion range, resection range and postoperative lung function(including FEV1% change in the predicted value and DLCO% change in the predicted value). However, the operative time in the two groups was(116.9±29.7)min in the dissection group, the non-anatomical group(107.3±28.6)min, comparison was made between the two groups( P=0.003). The number of days after thoracic drainage extraction in the anatomical group(5.6±3.8)days, non-anatomical group(6.9±5.0)days, there was a statistical difference between the two groups( P=0.03). In terms of postoperative complications, the number of patients admitted to hospital more than 2 times for postoperative hemoptysis, bronchopleural fistula and pulmonary infection within 1 year in the non-anatomical group was higher than that in the anatomical group, but there was no statistical difference. Conclusion:For patients with bronchiectasis requiring surgical treatment, thoracoscopic dissection combined with pulmonary segmental resection is safe and conducive to recovery, and has less complications, which is worthy of promotion.
ABSTRACT
The risk of perioperative venous thromboembolism (VTE) is pretty high in thoracic cancer patients. Perioperative VTE influences the recovery of patients after operation and quality of life in the future, even seriously leading to death. To strengthen the knowledge and attention of thoracic surgeons on perioperative VTE in thoracic cancer patients, China National Research Collaborative Group on VTE in Thoracic Surgery released the edition of VTE prophalaxis in thoracic cancer patients: Chinese experts consensus in 2018. This article is to interpret the diagnostic value and risk prediction value of D-dimer in VTE in detail, and briefly introduce the role of other biomarkers in VTE of tumor patients. The consensus interpretation aims to deepen the understanding of thoracic surgeons on the clinical significance of D-dimer in VTE.
ABSTRACT
Objective The aim of this study was to investigate the diagnostic value of the intravoxel incoherent motion (IVIM) for discriminating nonmetastatic from metastatic mediastinal lymph nodes in lung cancer.Methods IVIM was performed preoperatively on 66 patients with lung cancer during October 2015 to June 2016 in Capital Medical University Affiliated Beijing Chaoyang Hospital.Preoperative examination including the chest MRI scan,chest CT,head MRI,bone scan-ning and the cardiopulmonary function.None of the patients was undergone any kind of treatment about the cancer before the examinations,the neoadjuvant chemotherapy or radiation therapy,immunotherapy and gene targeted therapy were included.Measured the short axis diameter and the IVIM parameters of the mediastinal lymph nodes,apparent diffusion coefficient(ADC),diffusion coefficient(D),pseudo-diffusion coefficient(D *),and perfusion fraction(f).All the patients underwent the lobectomy or wedge resection and lymph node dissection or systematic sampling.By comparing the IVIM parameters of the nonmetastatic and metastatic mediastinal lymph nodes according to the pathological examination,draw the ROC curves to find the best cutoff value for diagnosis.And 42 cases were used to comparing the value of the MRI and CT in differential diagnosis.Results MRI measured 184 groups mediastinal lymph nodes,including 164 groups without metastasis,20 groups with metastasis.The ADC,D,D *,f values and short axis diameter of the nonmetastatic lymph nodes(n =164) were(2.880 ± 0.785) × 10-3 mm2/s,(0.670 ± 0.179) × 10-3 mm2/s,(0.383 ± 0.123) × 10-3 mm2/s,0.422 ± 0.119,(6.546 ± 1.932) mm,respectively,and (1.897 ±0.657) × 10-3 mm2/s,(0.472 ±0.210) × 10-3 mm2/s,(0.354 ±0.130) × 10-3 mm2/s,0.412 ±0.090,(7.510 ± 2.773) mm respectively for the metastatic lymph nodes (n =20).The ADC and D value of the nonmetastatic lymph nodes were significantly higher than the metastatic lymph nodes(P ＜0.01).While the other paraneters(D *,f,and short axis diameter) between the two groups did not show significantly different.Optimal cutoff values(area under the curve,sensitivity,and specificity) for distinguishing metastatic from nonmetastatic lymph nodes were as follows:ADC =1.890 × 10-3 mm2/s (0.871,92.7％,80.0％);and D =0.648 × 10-3mm2/s(0.740,70.0％,84.1％).Conclusion IVIM is useful to distinguish metastatic from nonmetastatic lymph nodes in lung cancer.The ADC and the D values are significant higher in metastatic lymph nodes,which more sensitive than the other parameters(D *,f,and short axis diameter).As a result,IVIM can be used in the N-stage diagnosis of lung cancer.
ABSTRACT
Objective Purpose This prospective randomized study was to explore the efficacy of different methods in preventing postoperative air leakage of video-assisted thoracoscopic (VATS) bullectomy for primary spontaneous pneumothorax.Methods The patients who underwent VATS bullectomy from January 2015 to March 2016 in Beijing Chao Yang Hospital were enrolled,and they were randomly assigned to experimental group and control group.The experimental group applied an absorbable polyglycolic acid(PGA) sleeve combining with an automatic stapler in the bullectomy.The control group resected the bullae using the automatic stapler alone.Covering the staple line with an absorbable polyglycolic acid sheet and pleural abrasion were performed in both groups.The baseline characteristics of the patients,postoperative air leakage,drainage tube removing time,postoperative hospital-stay,and postoperative complication were recorded.Results Finally,123 patients were enrolled in the study,the experimental group and control group were 58 and 65 cases,respectively.There was no operative mortality in either group.Compared with the control group,the postoperative air leakage (0.53 ± 0.99) days,chest tube drainage (2.98 ±1.03) days,postoperative hospital-stay (3.88-± 0.91) days in the experimental group were all significantly shorter.The rate of postoperative complications in the experimental group was(3.4％),of which one patient catched a pulmonary infection,the other one postoperative atelectasis.However,complications were developed in ten patients (15.4％) in the control group,which was significantly higher compared with the experimental group,including pulmonary infection five cases,postoperative atelectasis three cases,pleural effusion two cases.Conclusion The appliance of PGA sleeve in the operation for primary spontaneous pneumothorax could effectively prevent postoperative air leakage,as well as reduce the postoperative drainage tube removing time.Furthermore,the patient could recover more soon from the surgery,and have a shorter hospital-stay.
ABSTRACT
Objective To detect the express of the pulmonary fibrosis factor CTGF,TGF-β1 and the senescence correlated β-Gal in the primary pulmonary bulla,and investigate the correlation of the pulmonary fibrosis factor,cell senescence and the development of the primary pulmonary bulla.Methods The expression of CTGF,TGF-β1 and β-Gal protein in the tissue of normal lung tissues and lung bullae were tested.The cell image extracted with the digital camera system was entered into the Image-pro Plus 6.0 morphology Image analysis system and analyzed with Semi-quantitative way.Results The expression level of TGF-β1 and CTGF in primary pulmonary bulla organization was obviously higher than that of normal lung tissue.There was a statistically significant difference(P ＜ 0.05).CTGF and TGF-β1 expression level had a significant correlation (r =0.965,P ＜ 0.01).β-Gal expression level of primary pulmonary bullae had no obvious difference with normal lung tissue.Conclusion CTGF and TGF-β1 may play an important role in the formation of primary pulmonary bulla.Both play a synergistic role in the formation of primary pulmonary bulla.Cell senescence is not relevanted with the formation of primary pulmonary bulla.
ABSTRACT
Objective@#To investigate the current status of prevention and treatment of venous thromboembolism (VTE) after thoracic surgery in China.@*Method@#Chinese thoracic surgeons were investigated by the online questionnaire which was based on the Chinese version of International VTE questionnaire added with 6 extra questions with Chinese characteristics.@*Results@#A total of 1 150 valid questionnaires were retrieved, accounting for about 20% of all the Chinese thoracic surgeons. The surgeons participating in this survey came from all over the country, most of whom were experienced professionals with high academic titles.For lung cancer patients, 66.96% (770/1 150) of the surgeons suggested that VTE prophylaxis should start 1 day after lung cancer resection, and 64.61% (743/1 150) of the surgeons suggested extending after discharge. For esophagestomy patients, and 48.35% (514/1 063) of the surgeons suggested that there was no need for patients to extend VTE prophylaxis after discharge. More than half of the surgeons participating in this survey made decision of the method and duration of VTE prophylaxis after lung cancer resection (53.91% (620/1 150)) or esophagectomy (52.49% (558/1 063)) depending on the clinical experience.Low molecular weight heparin was the common choice of most surgeons in VTE prophylaxis. More than half of the surgeons thought that previous history of VTE, advanced age, complicated with thrombophilia, obesity (body mass index>30 kg/m2), duration of surgery longer than 6 hours and family history of VTE were key risk factors of the occurrence of postoperative VTE.@*Conclusions@#The results of this survey are highly credible and are a good reflection of the current status of VTE prevention and treatment after thoracic surgery in China. This survey will play an important role in promoting VTE prevention and treatment in Chinese thoracic surgery department, it will also provide data support for government setting new policies, hospital construction of VTE prevention and control as well as raising physicians′ awareness.
ABSTRACT
Objective To observe the changes of thoracic drainage volume after lung transplantation,and to explore the influencing factors and their relationship with the prognosis of lung transplantation.Methods This retrospective analysis included 46 consecutive lung transplantations in our hospital between 2005 and 2016.The volume of postoperative chest drainage was recorded and analyzed.Single factor analysis of the factors that may affect the drainage was done.The patients were divided into different groups according to different prognosis at different time points after operation,and drainage volume was compared among groups.All analyses were performed with SPPS,version 19.0.Results There were no operative deaths.The median thoracic drainage time was 9.3 days,the median total thoracic drainage volume was 4318 mL,and the average daily drainage volume was 487 mL.During the perioperative period,the use of cardiopulmonary bypass or extracorporeal membrane oxygenation increased significantly the volume of unilateral pleural drainage (P＜0.05).The average daily drainage volume and the average daily unilateral pleural drainage volume in the postoperative dead patients were significantly greater than those of survivals at 1 st month,3rd month and 1 st year after lung transplantation (P＜0.05).At 3rd month after transplantation,the total amount of postoperative thoracic drainage was significantly greater than that of survivals (P＜ 0.05).The average daily unilateral pleural drainage volume in dead patients after surgery was significantly greater than that of the survival patients 3 years after operation (P＜0.05).Conclusion Intraoperative hemostasis in patients with lung transplantation should receive considerable attention,cardiopulmonary bypass and extracorporeal membrane oxygenation should be used cautiously during perioperative period,and greater postoperative chest drainage predicated poor short-term prognosis.
ABSTRACT
Objective To observe the changes of thoracic drainage volume after lung transplantation,and to explore the influencing factors and their relationship with the prognosis of lung transplantation.Methods This retrospective analysis included 46 consecutive lung transplantations in our hospital between 2005 and 2016.The volume of postoperative chest drainage was recorded and analyzed.Single factor analysis of the factors that may affect the drainage was done.The patients were divided into different groups according to different prognosis at different time points after operation,and drainage volume was compared among groups.All analyses were performed with SPPS,version 19.0.Results There were no operative deaths.The median thoracic drainage time was 9.3 days,the median total thoracic drainage volume was 4318 mL,and the average daily drainage volume was 487 mL.During the perioperative period,the use of cardiopulmonary bypass or extracorporeal membrane oxygenation increased significantly the volume of unilateral pleural drainage (P＜0.05).The average daily drainage volume and the average daily unilateral pleural drainage volume in the postoperative dead patients were significantly greater than those of survivals at 1 st month,3rd month and 1 st year after lung transplantation (P＜0.05).At 3rd month after transplantation,the total amount of postoperative thoracic drainage was significantly greater than that of survivals (P＜ 0.05).The average daily unilateral pleural drainage volume in dead patients after surgery was significantly greater than that of the survival patients 3 years after operation (P＜0.05).Conclusion Intraoperative hemostasis in patients with lung transplantation should receive considerable attention,cardiopulmonary bypass and extracorporeal membrane oxygenation should be used cautiously during perioperative period,and greater postoperative chest drainage predicated poor short-term prognosis.
ABSTRACT
Objective Summarize the experience of diagnosis and treatment of esophageal rupture.Methods Twelve cases of esophageal rupture were treated with surgical intervention and clinical data were analyzed retrospectively.Diagnosis was confirmed in all patients by chest X-cays,Closed thoracic drainage,upper gastrointestinal contrast,chest CT scan and gastroscopy.In this series,there were 6 cases of spontaneous esophageal rupture,2 cases of iatrogenic esophageal rupture,4 cases of foreign body in esophagus rupture.For surgical treatment of 8 cases,including emergency esophageal stitching issue and diaphragmatic muscle or greater omentum to cover 6 cases;Esophageal ligation and resection of rupture area on both closes of the near and far,phase ii gastroesophageal anastomosis of esophagus resection in 2 cases,including 1 case of esophagus repair failure after turning the operation).Esophageal resection of gastroesophageal anastomosis in 1 case (for into the outer court misdiagnosed patients);4 cases were conservative.Results Initial diagnosis of spontaneous esophageal rupture and iatrogenic esophageal rupture 7 patients were cured,17 to 53 days of hospital stay,Follow-up for 3 months to 5 years,no esophageal related complications.Exception 1 patient died of postoperative infection(misdiaguosed for a long time).4 cases of esophageal foreign bodies to rupture were cured and these cases' fissure were less than 5 mm by chest CT scan and gastroscope diagnosis.Conclusion Complete collection of medical history,chest X-cays,Closed thoracic drainage,upper gastrointestinal contrast,chest CT scan and gastroscopy may clear diagnosis.Choose the proper method according to the patients as early as possible by general closed gap is the key to the treatment,at the same time be adequate drainage,control of infection and nutrition support treatment.
ABSTRACT
Objective Spontaneous pneumothorax occurred mainly because of bulla rupture and its formation process and pathogenesis were unknown,the study was to detect the express level of the cytokines KL-6,FGF-10 and MMP-9 in the spontaneous pneumothorax patients with bulla and researched its significance.Methods Selected 24 cases of bulla resection for spontaneous pneumothorax patients,the immunohistochemical staining techniques and enzyme-linked immunosorbent assay (ELISA) was taken to detect the expression level of KL-6,FGF-10 and MMP-9 of the bulla site and the bulla adjacent site.Results Immunohistochemical results showed that the staining intensity of the KL-6 and FGF-10 in groups of bulla site was higher than those in groups of bulla adjacent site while there was no significant difference of MMP-9 in the two groups.ELISA results showed that the expression levels of the KL-6 and FGF-10 in groups of bulla site are higher than those in groups of bulla adjacent site and the results had statistically significant (P ＜ 0.05),while there was no statistically significant of MMP-9 in the two groups(P ＞0.05).Conclusion The expression of the KL-6 and FGF-10 in the bulla site in primary spontaneous pneumothorax patients was higher than that in the normal site ; the pulmonary fibrosis mediated by KL-6 and the lung-bronchial congenital abnormalities mediated by abnormal expression of FGF-10 might have correlation with bulla formation.There was no statistically significant of the MMP-9 expression between the two groups and the correlation between inflammation mediated by MMP-9 and bulla formation was not clear.
ABSTRACT
Carcinoma of the esophagogastric junction can be radically resected through thorax or abdomen.Because abdominal operation can achieve more ideal abdominal lymph node dissection and less injury of respiratory function,it is ideal for the elderly patients and patients with poor pulmonary function.The classic laparoscopic radical gastrectomy needs a small abdominal incision for making tubular stomach and installation of stapling devices.All the procedures were completed via the main operating trocar.In November of 2011,a 65-year-old male patient with poor pulmonary function and carcinoma of the esophagogastric junction underwent modified total laparoscopic esophagogastric anastomosis.During the operation,the thorax esophagus was mobilized about 5 cm above the esophageal hiatus,then it was pulled to the abdominal cavity and transected.After inserting the OrVil via the mouth,the esophagogastric anastomosis was done.The operation went through smoothly and the procedure was completed conveniently and quickly.The patient recovered well after operation with no local recurrence and metastasis.
ABSTRACT
ObjectiveTo discuss the clinical experience and influence factors of airway complications after lung transplantation for end-stage lung diseases through reviewed 28 lung transplantation cases in our center.MethodsFrom August 2005 to December 2010,28 patients with end-stage lung diseases received lung transplantations consecutively in our center,in which 13 patients were bilateral-lung transplantation(BLT) and 15 patients were single-lung transplantation(SLT).The donor lungs were perfused with LPD solution antegrade and retrograde followed.During operation,the pulmonary artery pressure and flow rate were tested real time through the transesophageal echocardiography and Swans catheter.Postoperative care of patients was in respiratory intensive care unit,and immunosuppressive drugs were adjusted according to blood drug concentration.ResultsThere were no airway complications including anastomotic fistula or stenosis found in all patients.The mortality was 7.2％ in the early postoperative period ( 1-30 days).Cumulative survival rate was 94.1％ ％ at 1 year,76.2％ at 2 years,and 71.4％ at 3 years respectively.Four patients (14.3％) died in the postoperative 90 days.Three patients were reanastomosed pulmonary artery in operation because of stenosis detected by transesophageal echocardiography.After operation,three patients were reoperated,in which two were bleeding and one was pulmonary bulla and pneumothorax.All patients were followed from 1 year to 6.1 years after operation.The quality of life was improved significantly.ConclusionThe well improved technique of lung transplantation is helpful to reduce the operation related complications,decrease the early mortality post operation and play the important role in the effects of quality of life and long term survival rate.The intraoperative transesophageal echocardiography examination could detect the anomalous situation of vascular anastomosis.At the same time the patients should get benefits from the routine and close follow-up.
ABSTRACT
Objective To investigate the galectin-3 (Gal-3) and osteopontin (OPN) expression in esophageal carcinoma and analyze its clinical significance.Methods Thirty-seven patients who suffered from esophageal carcinoma were selected from 2006 to 2008.There were 28 males and 9 females,aged from 41 to 82 vears old.The levels of Gal-3 mRNA and OPN mRNA in tissues were detected by Fluorescent PCR,and the levels of Gal-3 and OPN in blood plasma were measured by ELISA.Result The expression of Gal-3 mRNA and OPN mRNA were significantly different between the esophageal carcinoma,side of carcinoma and normal esophagus tissues (F=11.934,F=4.269,P<0.05);The expression of galectin-3 and osteopontin were correlated with pathological grading (F=3.216,P<O.05),but not with the patient's age,gender and pathologic type.In metastasis group,the Gal-3 mRNA and OPN mRNA expression levels were significantly higher that that in un-metastasis group (P<O.05).Conclusion Different expression of Gal-3 and OPN may be related to the incidence.development and metastasis of esophageal cancer.Detection of Gal-3 and OPN of preoperative peripheral blood could be one of the important indicators,which could determine micrometastasis of esophageal carcinoma before operation.
ABSTRACT
Objective To extract the loci of murine MHC gene and construct plasmids.Methods The RNA of mice was extracted and reversely transcribed into cDNA.By using nested PCR,the products were connected with T vector,cloned,and sequenced.Subsequently,the genes were digested by endonucleases,connected with expression vector,and sequenced again to choose the correct clones.Results After the nested PCR,the products were approved by sequencing.After being connected with the vectors,they were approved again by sequencing and the correct clones were chosen.Conclusion All of the loci of the MHC gene can be obtained by nested PCR.The plasmids from the correct clone can be used in the further experiments of transferring the gene to mitigate the transplantation rejection.