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BACKGROUND@#Segmentectomy can retains more healthy lung tissue than lobectomy, but it remains controversial in oncology for early stage lung cancer. The aim of this study is to discuss the problems of video-assisted thoracic surgery (VATS) segmentectomy in early stage lung cancer, by analyzing the clinical and pathological data of 35 cases and reviewing the literature.@*METHODS@#There were 35 patients who received segmentectomy by complete video-assisted thoracic surgery, from May 2013 to July 2017, in single operation group in the Third Hospital of Peking University. We analyzed the patient's clinical and pathological data, intraoperative and postoperative complications, lymph node number and metastasis its situation, and compared postoperative pathology and preoperative computed tomography (CT) imaging type. In 35 cases of segmentectomy, there were 11 males and 24 females, with an average age of 57.7 years old. The lesions located in the right upper lobe were 8 cases, in the right lower lobe were 8 cases, in the left upper lobe were 13 cases, in the left lower lobe were 6 cases. The mean maximum diameter of CT imaging was 12.7 mm, and the largest diameter of hilar and mediastinal lymph nodes was less than 10 mm. 23 of them were ground glass predominating and 12 were solid components predominating.@*RESULTS@#All 35 cases were successfully completed VATS anatomical segmentectomy. The average operation time was 153 minutes, the amount of bleeding was 51 mL. There were 10 cases of air leakage after operation, all of which were not more than 3 days. There was contralateral atelectasis in 1 case, chylothorax in 1 case. The average length of hospitalization was 6.1 days. There was no other complications outpatient related to surgery, in 30 days after discharge. The pathological changes were as follow, 2 cases of metastatic tumor, 8 cases of benign lung disease and 25 cases of primary lung cancer. In the 25 cases of primary lung cancer, there were 14 cases of invasive lung adenocarcinoma (7 cases were groundglassopacity (GGO) predominating in CT imaging), 4 cases of micro-invasive adenocarcinoma (3 cases were GGO predominating in CT imaging), 6 cases of adenocarcinoma in situ (all were pure GGO in CT imaging), 1 case of lung squamous cell carcinoma (mainly composed of solid in CT imaging). An average of 7.2 lymph nodes were removed in 25 cases of lung cancer, and all lymph nodes had no metastasis.@*CONCLUSIONS@#VATS anatomical segmentectomy is technically safe and reliable, and the indications for lung cancer need to be strictly controlled. Its advantages still need to be confirmed by prospective randomized controlled trials.
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Female , Humans , Male , Middle Aged , Lung Neoplasms , Pathology , General Surgery , Neoplasm Staging , Retrospective Studies , Thoracic Surgery, Video-Assisted , MethodsABSTRACT
Aiming at the problems in the post competency training of eight year clinical medical students such as the deficiency of humanistic spirit and communication ability,insufficient capacity of clinical skills training and clinical problem-solving,the lacl of academic research ability and innovative spirit,and according to the practical requirements for clinical personnel,we elaborated the required post competence for eight-year medical students on the basis of its basic concept and intention.We proposed strengthening the cultivation of eight-year medical students by improved course plan and cultivation process,perfected assessment system,enhanced construction of teachers in order to make the students competent to their posts,and we also made some beneficial attempts in formulating and implementing the talent training scheme based on post competency.
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[Summary] Pectus excavatum ( PE ) is a posterior intrusion of the chest wall into the thoracic cavity . Although the physiological and psychological consequences vary , for a large number of patients the lesions are troublesome enough that they need corrective surgery .The minimally invasive repair of pectus excavatum ( Nuss procedure ) has been performed safely , effectively , and extensively .The current situations and progresses associated with the Nuss procedure were reviewed .
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Objective To evaluate the efficacy of video-assisted mini-thoracoscopy(VAMT) for radical resection of lung cancer.Methods From April 2002 to December 2008,radical resection of lung cancer was performed on 39 patients by VMAT in our hospital.A 1.5-cm and a 7-to 10-cm incision were made during the operation.Both standard surgical instruments and thoracoscopic set were used to treat the pulmonary vessels,perform lobectomy,and remove the lymph nodes in the mediastinum and pulmonary portal.Results The operation was completed in all of the cases.No peri-operative death occurred.The patients received chest drainage for 4 to 7 days after the operation(mean,4.5 days).Post-operative pathological examination showed primary non-small cell lung cancer(NSCLC) in 37 cases,metastatic cancer in 1,and carcinoid in 1.In the 37 patients with NSCLC,9 were stage Ⅰa,13 were Ⅰb,5 were Ⅱa,7 were Ⅱb,2 were Ⅲa,and 1 was Ⅲb.Follow-up was available in 35 patients for up to 2 to 12 months in 4,13 to 24 months in 15,25 to 36 months in 8,37 to 48 months in 6,and 49 to 60 months in 2 cases.Among the 35 cases,totally 4 patients died of tumor recurrence or metastasis,1 patient survived with tumor,and the other 30 survived without tumor.The 1-and 3-year survival rate of stage Ⅰ and Ⅱ were 100%(21/21) and 91%(10/11) respectively.All of the 3 stage Ⅲ patients died of recurrence or metastasis in 19,11,and 14 months respectively after the surgery.Conclusions VAMT is effective for radical resection of lung cancer in a short term.Combination of traditional procedure and VAMT is safe and reliable for the disease.
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Objective To report our experience on video-assisted thoracoscopic surgery(VATS)and perioperative management for patients over 70 years old.Methods From May 1998 to May 2008,78 patients over 70 years old were treated by VATS.Operative risk was evaluated by measuring forced expiratory volume in first second(FEV1),diffuse capacity of carbon monoxide(DLCO),and left ventricular ejection fraction(LVEF),and artery blood gas analysis and exercise test before the operation.VATS(n=46)or video-assisted minithoracotmy(n=32)was carried out under general anesthesia with a double-lumen tube.Extubation was delayed in 11 patients after the procedures and mechanical ventilation was employed to smooth anesthesia recovery.Results Postoperative pathological examination showed primary lung cancer in 20 cases,benign pulmonary lesions in 26,pleural mesothelioma in 3,malignant pleural metastasis in 5,empyema in 5,benign mediastinal tumor in 15,hiatal hernia in 3,and esophageal leiomyoma in 1.Postoperative morbidity was 33.3%(26/78)in this series,none of the patients died during the operation;the perioperative mortality was 2.6%(2/78).Conclusions VATS is safe for elderly patients.Satisfying outcomes can be achieved through strict preoperative evaluation,proper operative method and active management for postoperative complications.
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Objective To study the feasibility of Video-assisted thoracoscopic thymectomy and the long term result of thoracoscopic thymectomy for myasthenia gravis. Methods 9 cases of thymus related disease were selected to undergo thymectomy though thoracoscopic approach from August 1996 to April 2001.Patients were followed up through outpatient service and telephone consultation. Results Of the 9 cases 2 cases were diagnosed as thymus cysts,1 cases thymoma,1 case malignant thymoma,1cases thymus carcinoma and 4 cases myasthenia gravis.Of the 4 cases of myasthenia gravis,3 cases were typeⅠ and 1 case was typeⅡb according to the modified Osserman classification.After thoracoscopic thymectomy 75% of patients had long-term good responses to surgery.The operation of one case of malignant thymoma was converted to lateral thoracotomy.One case of malignant thymoma with myasthenia gravis relapsed and reoperated through open thoracotomy . Conclusions video-assisted thoracoscopy can be usd to treat seleted thymic diseases .The results of video-assisted thoracoscopic thymectomy for mysthenia gravis is almost comparable with traditional open thoracotomy
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0.05). Sixteen patients in the video-assisted thoracic surgery group were followed up for a mean of 42.9 months (20-88 months), during which no recurrence was detected. In the minithoracotomy group, 18 patients received an 18-to 71-month follow-up (mean, 41.2 months), none of them had recurrence. Conclusions The outcomes of both the operations are satisfying for middle-aged or elderly patients with spontaneous pneumothorax. However, video-assisted thoracic surgery should be the first choice.
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Objective To investigate the efficacy of thoracoabdominal mini-incision surgery for the treatment of gastric cardia cancer. Methods Radical resection of gastric cardia cancer was performed on 60 patients from January 2002 to January 2007. Thoracoabdominal mini-incision was used in 30 cases, and posterolateral thoracotomy was carried out in the other 30 patients. The data of the two groups were retrospectively analyzed. Results The operations were accomplished without death or severe complications in all the patients. Compared with the posterolateral thoracotomy group, thoracoabdominal mini-incision group had shorter incisions [(12.4?0.7) cm vs (19.2?2.0) cm, t=-17.577, P=0.000], shorter operation time [(207.3?76.1) min vs (260.0?85.6) min, t=-2.519, P=0.015], earlier postoperative ambulation [(2.3?0.5)d vs (3.4?0.5) d, t=-8.521, P=0.000], less thoracic drainage [(276.7?58.7) ml vs (308.7?59.5) ml, t=-2.097, P=0.040], less analgesic (pethidine) requirement [(66.7?27.3) mg vs (113.3?45.4) mg, t=-4.818, P=0.000], shorter duration of oxygen use [(3.8?2.0) d vs (5.1?2.6) d, t=-2.171, P=0.034], and higher arterial oxygen saturation[(97.6?2.7)% vs (96.1?2.7)%,t=2.152,P=0.036]. No significant difference was observed between the two groups in the number of dissected thoracic lymph nodes (1.87?0.43 vs 1.93?0.37, t=-0.579, P=0.565), number of dissected celiac lymph nodes (4.00?0.45 vs 3.97?0.49, t=0.247, P=0.806), postoperative hospital stay [(11.8?1.0) d vs (12.0?1.2) d, t=-0.701, P=0.486), pulmonary infection (2 vs 5, ?2=0.647, P=0.421), atrial fibrillation (2 vs 4, ?2=0.185, P=0.667) and positive surgical margins (0 vs 1, ?2=0.000, P=1.000). The two groups were followed up for (36.3?13.9) months and (36.3?16.5) months, respectively (t=0.024, P=0.981), no significant difference was detected between them in the 1- and 3-year survival cases (19 vs 22, ?2=0.487, P=0.485; and 10 vs 12, ?2=0.194, P=0.660) and chest pain (2 vs 3, ?2=0.000, P=1.000) during the period. Conclusions By using a thoracoabdominal mini-incision, gastric cardia cancer can be resected completely with less trauma. The approach is ideal for clinical application.