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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 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 To compare the effect of thoracoscopic and laparoscopic surgery with conventional thoracic surgery on esophageal cancer and its influence on pulmonary function. Methods Ninety?four patients with esophageal cancer treated in the Second Affiliated Hospital of Chengdu Medical College from March 2010 to March 2016 were selected and were divided into the control group ( 54 cases) and the study group ( 40 cases) according to operation methods. The control group received traditional thoracotomy. The study group received thoracoscopic and laparoscopic surgery. The operation and pulmonary function indexes were compared. Results The operation time of the patients in the study group was significantly longer than that in the control group ( (218. 1±35. 8) min vs. (192. 3±40. 1) min,t=3. 23,P 0. 05 ) . Conclusion Thoracoscopic and laparoscopic surgery for esophageal cancer has the advantages of small trauma,rapid recovery and low incidence of complications and obvious protective effect on pulmonary function. It is safe and feasible.
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To analyze congenital sensorineural hearing loss combined with blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). For the case of cochlear implantation to child with congenital sensorineural deafness combined BPES, accomplish routine examination and assessment, combining with literature to analyze the clinical diagnosis of this disease and its significance. Sensorineural hearing loss is a common congenital diseases with neonatal incidence of 1 per thousand - 3 per thousand, 50%-70% of deafness is associated with genetic factors, the incidence of congenital sensorineural hearing loss combined with eye disease is about 40%-60%, mainly reflected in ametropia and retinopathy. BPES's main clinical manifestations is blepharophimosis, ptosis, epicanthus inversus, and telecanthus. BPES is a rare autosomal dominant disease caused by FOXL 2 gene mutation, sometimes associated with retarded growth, delayed development, congenital heart disease, and microcephaly. Suffering from both sensorineural hearing loss and BPES is rare in reported literature. This case is diagnosed by clinical examination, without visual impairment. Facial nerve dysplasia has been found during the surgery. For congenital deafness patients with eye disease or other diseases, timely and correct diagnosis has important clinical significance, which can improve the diagnostic rate and make it coming true to early intervention, and then, effectively improve the quality of the patients. There are few literature reports, of patients with two kinds of genetic diseases. Our inference is that the cases are rare or the patients has visited different departments and ignored the other systems' signs. Therefore, in such doubtful cases, we should do the professional comprehensive examination in daily clinical work in order to avoid missed diagnosis or delayed treatment and intervention. By analyzing this case, the patient may also suffer from facial nerve dysplasia. Preoperatively viewing CT scan and operatively facial nerve monitor being used can avoid the occurrence of surgical complications.
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Child , Humans , Blepharophimosis , Genetics , Forkhead Transcription Factors , Hearing Loss, Sensorineural , Diagnosis , Mutation , Skin Abnormalities , Genetics , Urogenital Abnormalities , GeneticsABSTRACT
Objective To evaluate the safety and efficacy of bovine pericardium wrapping stump after distal pancreatectomy in a porcine model.Methods Thirty-two swine were randomly assigned to control group (n =16,conventional scalpel transection with hand-sewn closure of the pancreatic remnant)and experiment group (n =16,bovine pericardium wrapping stump combined with hand-sewn).Closedsuction drainage was collected daily until the tenth postoperative day.Animals were killed for necropsy at 3 weeks postoperatively and the pancreatic remnant was sampled for histology.Results The incidence of pancreatic leak in the wrapping group was lower than that in the control group (6.2 vs.46.7％,P ＜0.05).The amount of drainage fluid was higher in the control group during the postoperative period (25.1 ml vs.54.2 ml,P ＜ 0.01).There were no differences in operative time or other clinical parameters measured.No other significant differences were found in macroscopic changes between the two groups.Histology demonstrated focal,chronic inflammation with necrosis at the stump in all animals.Conclusions Bovine pericardium wrapping stump effectively reduced the incidence of pancreatic leakage after distal pancreatectomy.
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ObjectiveTo evaluate the instant response and side effects of hypofractionated high-dose 3-dimensional conformal radiotherapy (3-DCRT) for esophageal carcinoma treatment.MethodsSixty-nine patients with esophageal carcinoma were treated by 3-DCRT and 91 patients with routine radiotherapy.The prescribed dose was from 3000 to 4500 cGy in 3-DCRT group, with fractionated dose 300 cGy, one dose a day and five doses a week.The reference dose curve was the 90％ of the isodose curve.For the routine radiotherapy group,the prescribed dose was from 4000 to 6600 cGy,fractionated by 180 ～200 cGy a time,once a day and 5 times a week.Results At the end of the radiotherapy, 3-DCRT produced CR 42.0％ (29/69) , PR 49.3％ (34/69) and instant response rate 91.3％, while routine radiotherapy produced CR 35.2％ (32/91), PR 59.3％ (54/91) and instant response rate 94.5％, respectively.The difference was not significant between the two groups(P ＞ 0.05) .The survival rates one year after the treatment were 82.6.0％ (57/69)and 84.6％ (77/91) ,respectively.The acute radiation esophagitis rate was 66.7％ (46/69) in 3-DCRT group and was 64.8％ (59/91) in routine radiotherapy grouprespectively.ConclusionHypofractionated high-dose 3-DCRT is feasible for treatment of esophageal carcinoma.
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OBJECTIVE@#To analyze the changing features of mandarin-tone recognition in lower prelingual children with cochlear implant after mapping.@*METHOD@#Twenty-nine children with CI were registered in this test, who were divided into two groups according to the age received the operation. They were group A whose ages were 3 to 4.5 years old, and group B whose ages were 5.0 to 6.5 years old. The time after first mapping was between 1.5 and -2.0 years. The test only included close-set phonetic recognition which was mainly used to evaluate Mandarin-tone recognition. The Phonetic Recognition List was used as the test material.@*RESULT@#The results showed that the percentages of correct recognition were same-single-syllable tones average (63.00+/-16.75)%; bi-syllable tones average (75. 60+/-11.18)%; single-character words average (72.38+/-11.39)% in A group children and respectively, (49.46+/-13.91)%; (64.71+/-9.64)%; (55.71+/-8.59)% in B group children. The recognition scores exceeded chance level in all results and they were better in A group. Statistical analysis(t test) showed significant difference between two groups.@*CONCLUSION@#The age is one of the most influence factors about Mandarin-tone recognition after implanting in pre-lingual children with CI. It is another important factor to influence studying Chinese after operation in the children.