Uniportal thoracoscopic decortication for stage Ⅲ tuberculous empyema of 158 cases / 中华外科杂志

Objective: To examine the safety and feasibility of uniportal video-assisted thoracoscopic (VATS) decortication in patients presenting with stage Ⅲ tuberculous empyema. Methods: From August 2017 to July 2020, 158 patients of stage Ⅲ tuberculous empyema underwent uniportal VATS decortication with partial rib resection and customized periosteal stripper in Department of Thoracic Surgery, Shanghai Pulmonary Hospital. There were 127 males and 31 females, aged (M(IQR)) 32(28) years (range:14 to 78 years). Follow-up was performed in the outpatient clinic or via social communication applications, at monthly thereafter. If there was no air leak and chest tube drainage was less than 50 ml/day, a chest CT was performed. If the lung was fully re-expanded, chest tubes were removed. All patients received a follow-up chest CT 3 to 6 months following their initial operations which was compared to their preoperative imaging. Results: There was one conversion to open thoracotomy. The operative time was 2.75 (2.50) hours (range: 1.5 to 7.0 hours), and median blood loss was 100 (500) ml (range: 50 to 2 000 ml). There were no perioperative mortalities. There were no major complications except 1 case of redo-VATS for hemostasis due to excessive drainage and 1 case of incision infection, The incidence of prolonged air leaks (>5 days) was 80.3%(126/157). The postoperative hospital stay was 5.00 (2.25) days (range: 2 to 15 days). All patients were discharged with 2 chest tubes, and the median duration drainage was 21.00 (22.50) days (range: 3 to 77 days). Follow-up was completed in all patients over a duration of 20 (14) months (range: 12 to 44 months). At follow-up, 149 patients(94.9%) recovered to grade Ⅰ level, 7 patients to grade Ⅱ level, and 1 patient to grade Ⅲ level. Conclusion: Uniportal VATS decortication involving partial rib resection and a customized periosteal stripper is safe and effective for patients with stage Ⅲ tuberculous empyema.

Protecting action of acupuncture-drug compound anesthesia with different frequency electroacupuncture on stress reaction in pneumonectomy / 中国针灸

<p><b>OBJECTIVE</b>To observe the protective effect of acupuncture-drug compound anesthesia with different frequency electroacupuncture on stress reaction in pneumonectomy and to explore potential mechanisms.</p><p><b>METHODS</b>Eighty patients scheduled for pneumonectomy were randomly divided into four groups, named group A, B, C and D, 20 cases in each group. General anesthesia and single lung protective mechanical ventilation were produced in all the groups. They were treated with acupuncture at Houxi (SI 3), Zhigou (TE 6), Neiguan (PC 6), and Hegu (Li 4) 30 min before general anesthesia, and then with Han's acupoint nerve stimulator (HANS-200). The acupuncture needles without needle bodies were pasted on the acupoints and the electroacupuncture were not turned on in group A, and the 2 Hz continuous wave were produced in group B, and 100 Hz continuous wave were produced in group C and the 2 Hz/100 Hz were produced in group D. The supplementary anesthesia medicine during pneumonectomy, heart rate (HR), mean arterial pressure (MAP), CD4+ /CD/ in venous blood before and after the surgery, and the contents of epinephrine (E) and cortisol (Cor) in plasma at the time of inter-room and outer-room were detected.</p><p><b>RESULTS</b>(1) The supplementary fentanyl in group B and C were lower than those in group A and D (P < 0.05, P < 0.01). (2) The MAP in the four groups at intratracheal intubation (T1) were all higher than those at before anesthesia (T0) (all P < 0.01), and the ascending extent in group B, C and D were lower than that in group A (all P < 0.01). The HR at T in group A was higher than that at T0 (P < 0.05) and there were no significant differences in the other groups (all P > 0.05), and the ascending extent in group B and D were lower than that in group A (both P < 0.05). The MAP and HR at the other moment in all the groups were maintained stable. (3) CD4+ /CD8+ in group A after pneumonectomy was lower than that before the surgery (P < 0.05), and there were no significant differences in the other groups (all P > 0.05). (4) The content of E and Cor after the surgery were all increased (all P < 0.01), and the ascending extent of E in group D was lower than that in group A (P < 0.05), and the ascending level of Cor in group B and D were lower than that in group A (P < 0.01) and group B compared with group C and D were got the same result.</p><p><b>CONCLUSION</b>Acupuncture-drug compound anesthesia can attenuate the stress reaction so as to protect organs under the condition of less drug and can alleviates the undulate phenomenon of MAP and HR at intubation and stabilize CD4+ /CD8+ after pneumonectomy. Among them, the 2 Hz and 2 Hz/100 Hz electroacupuncture groups have the comparatively better effects.</p>

Lung transplantation in a Chinese single center: 7 years of experience / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Lung transplantation (LT) is a viable option for patients with end-stage lung diseases, but in China, the supply is limited, and the experience with LT is rare too. This study aimed to evaluate the survival and postoperative complications of recipients undergone LT.</p><p><b>METHODS</b>From January 2003 to May 2010, all patients who underwent LT were included. The clinical data of recipients were analyzed retrospectively, including demographic characteristics, survival rate, and the occurrences of postoperative complications, acute rejection and bronchiolitis obliterans syndrome.</p><p><b>RESULTS</b>In total, 37 patients underwent LT. The early mortality (≤ 30 days) was 14% (5/37). Cumulative survival rate was 78%, 70%, 70% and 42% at 1, 3, 5 and 6 years, respectively. In 37 patients, 5 (14%) developed fungal infections, 9 (24%) pulmonary bacterial infections, and 6 (16%) had bronchial anastomosis complications after LT. At three months post-transplantation, a significant improvement was observed in lung function (P < 0.05). Fifteen recipients (41%) developed acute rejection within the first year. Freedom from bronchiolitis obliterans syndrome was 89%, 85% and 80% at 1, 2 and 3 years after transplantation.</p><p><b>CONCLUSIONS</b>Despite the limited number of cases, the survival and occurrences of complications after LT were comparable to the international experience. Single LT may be a reasonable option for some patients with end-stage pulmonary diseases.</p>

Cytokine responses after lobectomy for early non-small cell lung cancer: a prospective randomized comparison of video-assisted thoracic surgery and open thoracotomy / 中华外科杂志

<p><b>OBJECTIVE</b>To compare video-assisted thoracic surgery (VATS) and open thoracotomy (OT) on acute inflammatory responses and immunosuppression after lobectomy for early non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>Present prospective randomized study. OT or VATS lobectomy was performed in patients who met enter criteria and clinical data was collected. Plasma concentration of IL-6, IL-8 and IL-10 were measured before surgery and at postoperative day (POD) 1 and POD 3. There were 271 patients underwent lobectomy for early NSCLC, including of 133 patients in group VATS and 138 patients in group OT from January 2007 to June 2008. There were 132 males and 139 females, aging from 19 ∼ 70 years with a mean of (56 ± 8) years.</p><p><b>RESULTS</b>Compared with OT group, shorter postoperative hospital stay [(8.2 ± 2.5) d vs. (9.8 ± 6.2) d, P = 0.03], lower morbidity rate (11.3% vs. 21.7%, P = 0.02) and lower increase of plasma concentration of IL-6 at POD 1 [(35 ± 25)% vs. (65 ± 43)%, P = 0.00], IL-6 at POD 3 [(14 ± 22)% vs. (55 ± 44)%, P = 0.00] and IL-10 at POD 1 [(25 ± 20)% vs. (43 ± 35)%, P = 0.00] were observed in patients of VATS group.</p><p><b>CONCLUSION</b>VATS lobectomy for early NSCLC is associated with less acute inflammatory responses and less immunosuppression when compared with OT.</p>

The early outcome of video-assisted thoracic surgery lobectomy for primary lung carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the early outcome of patients who underwent video-assisted thoracic surgery (VATS) lobectomy for primary lung carcinoma.</p><p><b>METHODS</b>The records of 121 patients with lung cancer undergoing VATS lung resection from 1997 to 2004 were reviewed retrospectively, I stage: 101 cases, 34 cases underwent right upper lobectomy, 13 cases underwent right middle lobectomy, 17 cases underwent right down lobectomy, 21 cases underwent left upper lobectomy, 16 cases underwent left down lobectomy. Thirty-eight cases underwent VATS lobectomy without assisted mini-incision.</p><p><b>RESULTS</b>There were 18 cases of morbidities (15%) and no surgical mortality. The 1-year, 2-year and 3-year survival rates of primary non-small cell lung cancer with I stage is: 99% (76/77), 96% (49/51) and 79% (15/19), respectively. There are statistic difference (P < 0.01) between adenocarcinoma and the others. There are no statistic difference (P > 0.05) between the VATS lobectomy with assisted mini-incision (n = 38) and without (n = 63), also no statistic difference (P > 0.05) between the VATS lobectomy and the standard procedure.</p><p><b>CONCLUSION</b>Our findings suggest that VATS lobectomy is superior regarding its ability to achieve the same survival rates and little morbidities in comparison with the standard procedure.</p>