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@#Objective To investigate the perioperative results and safety of minimally invasive direct coronary artery bypass grafting (MIDCAB) treatment of anterior descending artery disease through a small left thoracic incision assisted by thoracoscopy. Methods The clinical data of 92 patients who received MIDCAB in our hospital from May 2014 to October 2018 were retrospectively analyzed, including 72 (78.26%) males aged 42-78 (61.2±7.48) years, and 20 (21.74%) females aged 30-80 (61.30±12.26) years. The perioperative complications, blood product use, left heart function changes, ventilator use time, ICU stay, hospital stay and other indicators were analyzed. Results Two (2.17%) patients were transferred to thoracotomy, 5 (5.43%) patients received blood products during the operation, 2 (2.17%) were subjected to secondary thoracotomy to stop bleeding, 4 (4.34%) had postoperative hypoxemia and 1 (1.08%) was reintubated. The ventilator use time was 3-227 (22.35±35.39) hours, the ICU stay was 16-777 (78.85±108.62) hours, and the postoperative hospital stay was 2-36 (8.86±6.05) days. One (1.08%) patient died in hospital. Conclusion MIDCAB for anterior descending artery disease has good perioperative results, especially for solitary anterior descending artery disease, which can reduce the use of blood products, and shorten the time of ventilator use after operation, ICU stay and hospital stay.
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Objective The aim of this study was to explore the effect of minimally invasive small incision surgery on early thoracic esophageal cancer patients and its impact on pain. Methods A total of 160 patients with early thoracic esophageal cancer who were treated in our hospital from March 2016 to March 2017 were randomly divided into the conventional surgery group and the minimally invasive small incision surgery group. Patients in the conventional surgery group were treated with routine operation,and pa-tients in the minimally invasive small incision surgery group were treated with minimally invasive small incision surgery. Vital capacity ( VC),forced expiratory volume 1(FEV1),visual analogue scale(VAS),hospitalization time,operation time and intraoperative bleed-ing volume were counted. Growth hormone(GH)was detected by ELISA. The levels of cortisol(Cor) and interleukin-8( IL-8) were measured by immunoassay and adverse reactions. Results The levels of VC and FEV1 in the minimally invasive small incision group were significantly higher than those in the conventional surgery group. The bleeding volume,operation time and hospitalization time were shorter than those in the conventional surgery group. The levels of GH and Cor,VAS score and incidence of adverse reaction rate were lower than those in the conventional surgery group,and the level of IL-8 was also higher in than that in the conventional surgery group. The difference was statistically significant(P<0. 05). Conclusion Minimally invasive small incision surgery is effective on the treatment of early thoracic esophageal cancer,relieving pain and reducing adverse reactions.
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Sclerosing pneumocytoma is now classified into adenomas of the lung tumor belonging to benign tumors . Multiple sclerosing pneumocytoma is rare .A fifty-nine years old female patient underwent minimally invasive small incision , muscle-and rib-sparing thoracotomy ( miMRST) in August 2012.A lobectomy was made for a 5-cm tumor at the right lower lobe of the lung and a wedge resection was made for another 0.7-cm tumor at the right middle lobe of the lung .Post-operative pathological diagnosis was multiple sclerosing pneumocytoma .No recurrence or metastasis was found after four years ' follow-up.
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[Summary] A single-incision video-assisted thoracoscopic sublobular limited resection was performed for a 2-cm pulmonary nodule at the right lower lobe of the lung in August 2014.The post-operative pathological diagnosis was inflammatory myofibroblastic tumor of the lung.No recurrence and metastasis was found after one year’s follow-up.
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Objective To investigate theeffect of the one-lung ventilation (OLV) on open heart surgery with right subaxillary minimally invasive small incision in infants. Methods We conducted a retrospective analysis of 316 infants undergoing open heart surgery through right axillary straight mini-thoracotomy in ourhospital from Jan-uary 2014 to December 2014. Ordinary tracheal tube was inserted into left bronchus during OVL in all patients. OLV with pressure-control mode was performed with FiO2 100% and I:E 1:1 ~ 1.5 and their respiratory rate and the pressure ventilation were adjusted to maintain SpO2 and ETCO2 in the normal range. Conventional ultrafiltration was performed after CPB and fluid restrictions were intraoperatively maintained. Blood samples were obtained for deter-mination of PaO2 and PaCO2 after induction of anesthesia (T1), at the time points: OLV 10 min (T2), OLV 30 min (T3), OLV10 min after CPB (T4) and the recovery TVL (T5). The HR, MAP, incidence of pneumothorax and me-chanical ventilation time were recorded and monitored as well. Result All patients lived through perioperative pe-riod, without pneumothorax. There were no significant differences in PaCO2, HR and MAP between time points. But PaO2 at the time point of T1 significantly lowerthan those at other time points of T2, T3, T4 and T5, but its indexes at all time points were in normal range. Conclusion The appropriate skills ofintubation, rational strategy of ventila-tion and intensive prevention of the lung may be good for the safe application of OVL in open heart surgery through right subaxillary minimally invasive small incision in infants.
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Objective To compare merits and shortages between minimally invasive small incision surgical repair and interventional device closure for isolated secundum atrial septal defect (ASD). Methods A retrospective analysis was made on clinical results of 69 patients with isolated secundum ASD from January 2004 to June 2006. Among them 37 patients underwent minimally invasive small incision surgical repair on the beating heart (Small Incision Group) and 32 patients underwent interventional device closure of ASD (Interventional Group). Results There were no deaths in either group. The small incision surgical repair was successfully completed in all the 37 patients, with the procedure time, cardiopulmonary bypass time, and hospital stay being 145.86?27.84 min, 35.11?8.45 min, and 15.46?3.09 d, respectively. Major and minor complications occurred in 2 and 6 patients, respectively. The hospitalization costs was 21 900?3600 yuan. In the Interventional Group, the closure was successfully performed in 30 out of 32 patients. The procedure time and hospital stay were 88.59?7.75 min and 10.81?5.02 d, respectively. Major and minor complications occurred in 1 and 2 patients, respectively. The hospitalization costs was 27 800?3900 yuan. Follow-up observations were performed in the Small Incision Group for 3~12 months in 20 patients and for 12~30 months in 17 patients, and in the Interventional Group for 3~12 months in 16 patients and for 12~30 months in 14 patients. No residual shunt was found. Conclusions Both of minimally invasive methods are safe and effective for isolated secundum ASD. Small incision surgical repair involves lower costs, higher successful rate, and broader indications, whereas interventional device closure offers shorter hospital stay, milder trauma, and better cosmetic results.