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Objective To monitor right heart hemodynamic changes of patients with lung cancer during and after the procedures of pneumonectomy and discuss the effect of pneumonectomy on right heart function and risk of postoperation morbidities. Method 16 patients with lung cancer were randomly selected and the clinical database was queried and Swan-Ganz catheter was applied awake from jugular vein to pulmonary artery ,measuring mean arterial pressure(MAP) ,heart rate(HR) ,central venous pressure(CVP) ,mean pulmonary artery pressure (MPAP),mean pulmonary capllary wedge pressure(MPCWP) ,and eardiaoc output(CO) and calculating cardiac index (CI),left ventricular-stroke work index (LVSWI), right ventricular stroke work index (RVSWI) , and stroke volume index(SVI) instantaneously before anaesthesia, after anaesthesia with single lung ventilation, after pulmonary artery and pulmonary vein occlusion and supine chest dosed during the procedure of pneumonectomy. Pre-and post-operative complications were recored. Results Cardiovascular complications occurred in 6 patients(37.5%) postoperatively. There were no operative or perioperative deaths. MPAP increased significantly after the procedure of pneumonectomy compared with that of preoperation, and MPAP > 26 mm Hg was in 4 patients who got cardiovascular complications postoperatively with morbidity of 100% ,which was "significantly higher than the morbidity of 16.7% (2/12) when MPAP < 25 mm Hg. Conclusion Pneumonectomy has significant effects on right heart hemodynemic changes and as MPAP increases postoperatively, the risk of cardiovascular complications becomes higher.
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Objective To report our experience on video-assisted thoracoscopic surgery(VAMT)for the treatment of benign esophageal neoplasm.Methods A total of 56 patients with benign esophageal neoplasm received VATS with or without auxiliary mini-thoracotomy in our hospital from March 1995 to January 2008.Under the assistance of a fiber gastroscope,through a 1.5-cm and two 2-cm incisions,the neoplasm was removed by using 3 trocars.In some cases,a 5-cm subaxillary incision was made.ResultsAmong the cases,the neoplasm was removed in 54 patients with VATS(with auxiliary mini-thoracotomy performed in 8),in which postoperative pathological examination showed esophageal leiomyoma in 47 and interstitialoma in 7.Two patients were converted to open surgery because of huge leiomyoma invading the muscular layer with an active growth,or low-malignant potential leiomyoma.Partial esophagectomy and end-to-end anastomosis were carried out in these two patients.No patient died intra-or peri-operation.No serious postoperative complication occurred in this series.A 2-to 128-month follow-up(mean,58.6 months)was achieved in 49 of the patients,none of them complained of dysphagia or developed recurrence during the period.Conclusions VATS(combined with mini-thoracotomy)is safe and effective for benign esophageal neoplasm.It can be the first choice for the treatment of the disease.
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Objective To explore the indications and safety of video-assisted thoracoscopic lobectomy with small auxiliary incision for benign pulmonary diseases and non-small cell lung cancer.Methods Between May 1996 and April 2007,63 cases of lobectomy were performed by video-assisted thoracoscopy.Before the operation,18 of the patients were diagnosed with benign pulmonary diseases,and 45 had pulmonary mass or malignancies.Lobectomy of the right lung was carried out on 47 patients,including the right upper lobe resection in 12,the middle lobe in 8,and the lower in 27.The other 16 patients received resection of the left upper lobe(5)or left lower lobe(11).Results Thoracoscopic lobectomy was completed in all the 63 patients,in 6 of them the incision was lengthened during the operation.No perioperative death occurred.The chest tube was withdrawn 4 to 7 days(mean,4.5 days)after the operation.Postoperative pathological examination showed NSCLC in 37 patients(58.7%),metastatic lung cancer in 1(1.6%),carcinoid tumor in 1(1.6%),and benign conditions in 24(38.1%).Among the 37 patients with NSCLC,8 were at stage Ⅰa,13 at stage Ⅰb,14 at stage Ⅱa,3 at stage Ⅱb,6 at stage Ⅲa,1 at stage Ⅲb,and 2 at stage Ⅳ.Of the patients with malignancies,34 were followed up for 2 to 60 months(2 to 12 months in 7,13 to 24 months in 10,25 to 36 months in 6,37 to 48 months in 6,and 49 to 60 months in 3),2 of them survived 11 years,5 of the patients(14.7%)died of tumor recurrence or metastasis,1(2.9%)survived with tumor,and 28(82.4%)lived free of tumor.The 1-and 3-year survival rate of the patients with stage Ⅰ or Ⅱ cancer were 100%(19/19)and 90%(9/10)respectively.In the patients with stage Ⅲ cancer,5 received follow-up,3 of them died of recurrence of metastasis.In the 2 patients who had stage Ⅳ cancer,1 died of metastasis.Conclusion Video-assisted thoracoscopic lobectomy is a safe and effective procedure and can be a regular surgical treatment for benign pulmonary disease,and peripheral type non-small cell lung cancer at stage Ⅰ or Ⅱ.
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<p><b>BACKGROUND</b>To explore the feasibility of extended resection in selective patients with centrally located lung cancer.</p><p><b>METHODS</b>From January, 1987 to December, 2001, lobectomy or pneumonectomy combined with extended resection of trachea, bronchus, heart or great vessels were carried out in 134 patients with centrally located lung cancer. The operations included bronchoplastic procedures in 80 cases, extended resection and reconstruction of left atrium and/or great vessels in 54 cases (32 cases with contemporary bronchoplasty).</p><p><b>RESULTS</b>Operative death occurred in one case. Postoperative complications happened in 16 cases (11.9%). One hundred and seventeen cases (94.4%) were followed up. The 1-, 3-, 5-year survival rate was 84.7% (61/72), 56.7% (34/60) and 45.7% (21/46) respectively, while of those combined with tracheo bronchoplasty and/or cardiovascular reconstruction, the 1-, 3-, 5-year survival rate was 69.2% (36/52), 46.8% (22/47) and 22.2% (8/36) respectively. (P < 0.05), while expression of KAI1 mRNA did not relate to mutant P53 protein expression (P > 0.05).</p><p><b>CONCLUSIONS</b>Extended resection combined with tracheo-bronchoplasty and/or cardiovascular reconstruction is feasible for selected patients with centrally located lung cancer and could improve the survival and life quality of patients.</p>
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Objective To retrieval the ways of prevent complications of video-assisted thoracoscopic surgery. Methods The operation included bullectomy in 462 patients, resection of mediastinal tumor or cyst in 86; esophageal diseases in 94, lobectomy or wedge resection of lung in 140, VATS hemostasis in 22, partial pericardial or pleural excision in 54 and biopsy for undetermined chest diseases in 54. Combined anesthesia with intubations of double lumen tracheal tube was performed in 866 patients and single-lumen tracheal tube in 46. Results 886 operations were completed by VATS, and 26cases were converted into thoracotomy for various reasons. Complications occurred in 36 patients (3.95%), including 10 cases occurred during the operation (esophageous mucous rupture in 4, nerve injury in 2 and insufficient hemostasis leading to postoperative bleeding in 4). 26 cases (2.85%) developed complications postoperatively, including persistent air leak (≥7 days) in 19, pleural effusion making a second water-sealed drainage necessary in 3, atrial fibrillation in 2 and infection in 1. One died for respiratory failure on the fifth postoperative day. Conclusion VATS experience should be gained systematically. In order to reduce the complications, more attentions must be paid to training of the thoracic surgeons in order to master the skill and the correlated knowledge of VATS.
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Objective To discuss the necessity of mediastinal lymph node dissection in the resection of lung cancer. Method 740 patients with lung cancer underwent lobectomy or pneumonectomy during Jan. 1987 to Dec. 2002 in our hospital were retrospectively analyzed. Totally 3492 lymph nodes were removed and checked up pathologically. Result Lymph nodes with metastasic were confirmed in 362 out of the 740 cases, and the metastasis ratio was 48.9%, and among them in 276 patients suffered N_2 lesion, with the ratio of 37.3%. The statistic result showed that lymph node metastasis was correlated to the location, cell type, the size, T stage and differentiation of lung cancer. Conclusion Lymph node metastasis in lung cancer is common and related to multiple factors. In order to obtain radical cure, both mediastinal and hilar lymph nodes should be removed.
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To evaluate and summary clinical experience in video assisted thoracoscopic surgery (VATS)for some thoracic diseases, clinical data of 616 patients (644 times) subjected to thoracoscopic surgery in our hospital from December 1993 to December 2001 were retrospectively analyzed. Among them, spontaneous pneumothorax occurred in 276 patients, emphysema in 44, mediastinal tumor or cyst in 55, esophageal diseases in 78, pulmonary malignant or benign diseases in 75, and other diseases in 65. Double lumen tracheal tubes were placed in 576 patients, single one was placed to ensure one lung ventilation in 6 patients and two lung ventilation in 34 patients. surgical procedures were completed by VATS in 593 cases, and 23 cases were converted into thoracotomy because of pleural adhesion or tumor invasion. Postoperative complications occurred in 24 cases with a morbidity rate of 4 0%. Persistent air leak (over 7 days) were noted in 15 cases and postoperative bleeding in 3. One case with spontaneous pneumothorax and type Ⅱ respiratory failure died of repiratory failure on the fifth day postoperatively. Six of 276 patients with spontaneous pneumothorax relapsed. VATS has more advantages than tranditional thoracotomy for some selected chest diseases,so thoracic surgeons shoulds convert tranditional thoracotomy method to perfom VATS step by step.
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Objective The purpose of this study was to investigate the clinical significance of pre-operative combined detection of metastasis-relative genes in non-small cell lung cancer. Methods Peripheral blood lymphocyte specimens from 46 patients before operation and fresh tissue specimens after operation were examined by RT-PCR analysis of CD44v6 and nm23H1 mRNA. The results were compared to the pathological diagnosis of lymph node metastases. ROC curve was used to determine the cut-off value of pre-operative metastases prediction. Results The relative amount of CD44v6 mRNA was higher (P