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@#Objective To analyze the feasibility of six-minute walk test (6MWT) before pulmonary lobectomy and prediction for postoperative outcome. Methods A total of 580 patients who were hospitalized in the department of lung surgery from May, 2017 to May, 2019 were reviewed, and 274 eligible patients were selected, who underwent first surgery and the surgical method was pulmonary lobectomy. They were divided into two groups based on the results of 6MWT before operation. The cut-off value of six-minute walk distance (6MWD) was obtained by receiver operating characteristic curve (ROC) area under curve (AUC). The postoperative outcome and the occurrence of cardiopulmonary complications in the two groups were analyzed. Results Compared to patients with 6MWD > 449 meters, the age was significantly older (P < 0.001), the forced expiratory volume in the first second (FEV1) was poor in patients with 6MWD ≤ 449 meters (P < 0.05), and other factors such as surgical resection site, pathological stage, gender, etc., were not significantly different (P > 0.05). The incidence of postoperative cardiopulmonary complications was significantly higher (OR = 2.672, 95%CI 1.488 to 4.798, P = 0.002), and the postoperative extubation time and hospital stay was longer in patients with 6MWD ≤ 449 meters than in patients with 6MWD > 449 meters (P < 0.05). 6MWD ≤ 449 meters was an independent risk factor for postoperative cardiopulmonary complications (OR = 2.395, 95%CI 1.299 to 4.415, P = 0.005). Conclusion As a simple function test, 6MWT can be routinely used to assess the physiological function of patients undergoing pulmonary lobectomy. Patients with 6MWD ≤ 449 meters may be in higher risks of postoperative cardiopulmonary complications.
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Objective To study l-arginine aerosolized inhalation's protective effect on pulmonary ventilation of the pulmonary-arterial-hypertension patients during the early stage after pulmonary lobectomy,and its preventive effect on reducing postoperative complications.Methods 54 cases of pulmonary lobectomy patients with preoperative plumonary arterial hypertension were divided into two groups randomly-Group A was given L-arginine aerosolized inhalation within 4 h after the operation;Group B was given the same dose of aerosolized inhalation of physiological saline as contrast(other postoperative medication being the same with Group A).Compare the two groups of patients in terms of oxygenation index(PaO2/FiO2),alveolararterial oxygen difference(PA-aO2),nitric oxide(NO) concentration,ultrasonic cardiogram,mechanical ventilation duration,ICU duration,occurances of hemodvnamic disturbance and arrhythmia,and differences in postoperative hospital stay.Results The oxgenation index and the content of NO in plasma of Group A were higher than that of Group B(P ＜0.001);the alveolar-arterial oxygen difference and the postoperative pulmonary arterial pressure detected by UCG of Group A were lower than that of Group B(P ＜ 0.001);the postoperative mechanical ventilation duration,ICU duration,occurances of hemodynamic disturbance and arrhythmia of Group A were all lower than that of Croup B(P ＜ 0.05).Conclusion The postoperative l-arginine aerosolized inhalation during the early stage after pulmonary lobectomy has positive effect on the lung protection of the pulmonary-arterial-hypertension patients and it can reduce the perioperative complications and postoperative hospital stay of such patients.
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ObjectiveTo explore the surgical technique and effectiveness of uniportal video-assisted thoracoscopic double-sleeve lobectomy and its clinical popularization value. MethodsThe clinical data of 19 consecutive patients (18 left-sided operations and 1 right-sided operation), who underwent uniportal video-assisted thoracoscopic double-sleeve lobectomy in Shanghai Pulmonary Hospital of Tongji University between Dec. 2016 and Jul. 2018, were included. Pre-, intra- and post-operative indicators were statistically analyzed, and the surgical patients were followed up. ResultsAmong 19 patients, there were 17 males and 2 females, with an average age of (62.3±6.6) years. The average operative time was (258.0±66.6) min, average operative blood loss was (210.0±157.8) mL, average bronchus anastomosis time was (26.0±5.8) min, average artery anastomosis time was (47.7±7.2) min, and average postoperative hospital stay was (7.6±4.5) d. Postoperative pathologic examination indicated that 15 cases had squamous cell carcinoma, 2 had adenocarcinoma, 1 had small cell carcinoma, and 1 had large cell carcinoma. TNM staging: 11 cases was IIIa and 8 was IIIb. Four patients suffered postoperative complications, including 1 case of thrombosis at the vascular anastomosis, 1 arrhythmia and 2 prolonged airleak. There were no bronchial anastomotic fistula and anastomotic stenosis, vascular anastomosis stenosis or operative death. The average followup time was (16.4±6.4) months and no tumor recurrence or metastasis was found during follow-up after operation. ConclusionUniportal video-assisted thoracoscopic double-sleeve lobectomy is a technique-demanding operation, which can be carried out in the thoracic centers with endoscopy proficiency. It is feasible for completely removing tumor, preserving lung function to the greatest extent, and reducing surgical trauma to achieve rapid recovery of patients.
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ABSTRACT Abdominal apoplexy is a rare clinical entity, and its clinical manifestations are diverse. This case report is of a 52-year-old man who developed right upper abdominal pain with unstable haemodynamics 32 hours after right upper pulmonary lobectomy for lung carcinoma. Abdominal computed tomography showed a ruptured right gastric artery aneurysm.
RESUMEN La apoplejía abdominal es una entidad clínica rara, y sus manifestaciones clínicas son diversas. Este es un reporte de caso de un hombre de 52 años que presentó dolor abdominal superior derecho con hemodinámica inestable, 32 horas después de una lobectomía pulmonar superior derecha por carcinoma del pulmón. La tomografía computarizada abdominal mostró una ruptura de aneurisma de la arteria gástrica derecha.
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Humans , Male , Middle Aged , Pneumonectomy/adverse effects , Aneurysm, Ruptured/etiology , Gastric Artery/diagnostic imaging , Tomography, X-Ray Computed , Retrospective Studies , Aneurysm, Ruptured/diagnostic imaging , Lung Neoplasms/surgeryABSTRACT
Introduction: Despite the increasing use of video-assisted thoracoscopic lobectomy, this surgical approach is still controversial in certain aspects. The purpose of this study is to compare the surgical results of video-assisted thoracoscopic pulmonary lobectomy to pulmonary lobectomy via thoracotomy. Materials and Methods: Between 2008 and 2017, 153 patients (n = 89 males) had surgery at the Hospital Universitario Fundación Favaloro. Results: 39/89 patients underwent video-assisted thoracoscopic lobectomy. Patients who had video-assisted thoracoscopy and were diagnosed with lung cancer mostly had stage I tumors (25/39 patients). Postoperative complications and mortality rates were similar in both groups. Video-assisted thoracoscopy patients had a significantly shorter pleural drainage time (4 vs. 3 days, p = 0.004) and a shorter length of hospital stay (6 vs. 4 days of stay, p = 0.03). The number of lymph node stations sampled during surgery was higher in the patients operated via thoracotomy (4 vs. 3.5 lymph node stations, p < 0.001). Conclusion: Video-assisted thoracoscopic lobectomy was at least equivalent to surgery by means of thoracotomy in terms of postoperative complications. The main benefits of the video-assisted thoracoscopy approach were shorter pleural drainage time and length of hospital stay. Special attention should be paid to nodal sampling when the surgery is performed via video-assisted thoracoscopy.
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Pneumonectomy , ThoracotomyABSTRACT
@#Objective To evaluate the clinical effects of harmonic scalpel application in thoracoscopic surgery for lung cancer, which may guide its reasonable application. Methods We retrospectively analyzed the clinical data of 145 lung cancer patients receiving thoracoscopic surgery from January to March 2017 in our hospital. There were 57 patients with thoracoscopic pulmonary wedge resection, and harmonic scalpel was used in 34 patients (8 males, 26 females at age of 59.68±10.91 years), and was not used in 23 patients (13 males and 10 females at age of 59.13±11.21 years). There were 88 patients receiving thoracoscopic pulmonary lobectomy, among whom harmonic scalpel was used in 80 patients (36 males and 44 females at age of 59.68±10.91 years), and was not used in 8 patients (5 males, 3 females at age of 61.63±5.60 years). We recorded the perioperative outcomes of all patients. Results In the 34 patients undergoing thoracoscopic pulmonary wedge resection by harmonic scalpe, the operation time was 90.09±43.52 min, the blood loss was 21.32±12.75 ml, the number of lymph nodes resected was 5.12±4.26, duration of drainage was 3.15±1.16 d, volume of drainage was 535.00±291.69 ml, the length of postoperative hospital stay was 4.56±1.40 d, and no postoperative complication was observed. In the 80 patients receiving thoracoscopic pulmonary lobectomy by harmonic scalpel, operation time was 131.88±41.82 min, blood loss was 42.79±31.62 ml, the number of lymph nodes resected was 13.54±8.75, duration of thoracic drainage was 4.47±2.30 d, drainage volume was 872.09±585.24 ml, the length of postoperative hospital stay was 5.81±2.26 d, and 20 patients had postoperative complications. No complication occurred in the 8 patients without harmonic scalpel. Conclusion Harmonic scalpel showed satisfactory effectiveness and safety in lung cancer thoracoscopic surgery.
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Objective To conduct the comparative study on postoperative serum CD 40 ligand (CD40L ) , tumor necrosis factor-α(TNF-α) and interleukin 6(IL-6) levels and arrhythmia in the patients with pneumo-nectomy and pulmonary lobectomy .Methods T he clinical data in 120 cases of non-small cell lung cancer (NSCLC) treated with lung cancer radical resection in this hospital from March 2013 to March 2016 were ret-rospectively analyzed ,among them 20 cases of thoracoscopic pneumonectomy served as the control group , w hile the other 100 cases of thoracoscopic pulmonary lobectomy served as the observation group .T he number of lymph node dissection ,operative time ,drainage time ,postoperative pain score ,intraoperative bleeding vol-ume and hospital stay time were compared between the two groups .Serum TNF-α,CD40L and IL-6 levels be-fore and after operation and occurrence of complications were compared between the two groups .Results The operative time ,drainage time ,postoperative pain score ,intraoperative bleeding volume and hospital stay time in the observation group were significantly lower than those in the control group ,the differences had statistical significance (P<0 .05) .The incidence rate of arrhythmia in the observation group was 5 .00％ ,which was sig-nificantly lower than 45 .00％ in the control group ;the total incidence rate of complications in the observation group was 12 .00％ ,which was significantly lower than 65 .00％ in the control group ,the difference was statis-tically significant (P<0 .05) .The serum TNF-α,CD40L and IL-6 levels before and after operation had statisti-cal difference between the two groups (P<0 .05) .Conclusion Compared with pneumonectomy ,adopting pul-monary lobectomy in the patients with lung cancer has shorter hospital stay time and drainage time ,less blood loss ,milder pain and slight postoperative inflammatory reaction and lower incidence rate of arrhythmia and other complications ,therefore ,w hich can serve as the first choice of operation method for treating lung cancer .
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Objective To evaluate the effect of sufentanil combined with dexmedetomidine on analgesia in patients with pulmonary lobectomy.Method Totally 80 patients with pulmonary lobectomy in Yanan University Affiliated Hospital were collected from January 2014 to August 2016,which randomly divided into two groups:patients in control group (n-40) were given sufentanil 0.05 μg/(kg·h),and patients in observation group (n =40) were given sufentanil 0.03 μg/(kg·h) combined with dexmedetomidine 0.07 μg/(kg·h),The differences of hemodynamic change,VAS and Ramsay score,and adverse reaction at 1 h,6 h,12 h,24 h and 48 h after operation were compared.Results The hemodynamic change of all patients were relatively stable,and the more stable group B with lower MAP,HR and DBP at 12 h,and SBP at 6 h after operation further contributed the recovery of patients,which difference compared with group A was significance (P ＜ 0.05).However,the difference of SpO2 at the same time after operation was no significance.The VAS score blow 4 showed that the analgesia of all patients was satisfying.Comparing group B with group A,the VAS score was lower after 6 h at post-operation,which difference was significance (P ＜ 0.05).The Ramsay score of group B was higher than group A at 6h and 12 h,which difference was significance (P ＜ 0.05).The Ramsay score with range from 2 to 4 showed the sedation of all patients was not deficient or excessive.The incidence of nausea and vomit (2.5％) and dizziness (0％) in group B was lower than group A,with significant difference between two groups (P ＜ 0.05).Conclusion Combination dexmedetomidine with sufentanil to relief postoperative pain in patients undergoing pulmonary lobectomy is deserved popularization in clinic,which not only increases the efficiency analgesia and sedation,improves hemodynamic,but also decreases sufentanil-induced side-effect.
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Objective:To compare the surgery indicators of early lung cancer patients between video-assisted thoracoscopic surgery and thoracotomy in order to provide suggestion for surgery scheme.Methods: 126 early lung cancer patients, from March 2014 to January 2016 stayed in our hospital, were chosen as observation object. They were divided in control group (63 cases, thoracotomy) and observation group (63 cases, video-assisted thoracoscopic surgery), and to compare series of surgery indicators, IL-6 and TNF-α between the two groups.Results: The operating time and blood loss of observation group were lower, and the dissected lymph node number of observation group was higher than control group, respectively, and both of the differences were statistical significant (t=6.568,t=3.096, P<0.05;t=3.659,P<0.05); the hospital stay, catheter-retaining time and pain score of observation group were lower than control group, and the differences also were statistical significant (t=15.850,t=12.379,t=10.272;P<0.05); the differences of IL-6 and TNF-α between two groups were no statistical significant before treatment, and both of them reduced after treatment; both of the IL-6 and TNF-αof observation group were lower than control group (t=13.073, t=1.629;P<0.05); on the other hand, the total rate of complications of observation group, such as pneumonia, pulmonary atelectasis and arrhythmia, were higher than control group (x2=0.208, x2=2.800,x2=0.341;P<0.05). Conclusion: Early lung cancer patients are more suitable for video assisted thoracoscopic surgery, and its effect is better and is more conducive to the rehabilitation of patients after surgery.
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@#Objective To investigate the perioperative outcome of robot-assisted pulmonary lobectomy in treating pathological stage Ⅰ non-small cell lung cancer (NSCLC). Methods We retrospectively analyzed the clinical data of 333 consecutive p-T1 NSCLC patients who underwent robotic-assisted pulmonary lobectomy in our hospital between May 2013 and April 2016. There were 231 females (69.4%) and 102 males (30.6%) aged from 20–76 (55.01±10.46) years. Cancer was located in the left upper lobectomy in 37 (11.1%) patients, left lower lobectomy in 71 (21.3%) patients, right upper lobectomy in 105 (31.5%) patients, right middle lobectomy in 32 (9.6%) patients, right lower lobectomy in 88 (26.4%) patients. Adenocarcinoma was confirmed in 330 (99.1%) patients and squamous cell cancer was confirmed in 3 (0.9%) patients. Results Total operative time was 46–300 (91.51±30.80) min. Estimated intraoperative blood loss was 0–100 ml in 319 patients (95.8%), 101–400 ml in 12 patients (3.6%), >400 ml in 2 patients (0.6%). Four patients were converted to thoracotomy, including 2 patients due to pulmonary artery branch bleeding and 2 due to pleural adhesion.No patient died within 30 days after surgery. And no perioperative blood transfusion occurred. Postoperative day 1 drain was 0–960 (231.39±141.87) ml. Chest drain time was 2–12 (3.96±1.52) d. And no patient was discharged with chest tube. Length of hospital stay after surgery was 2–12 (4.96±1.51) d. Persistent air leak was in 12 patients over 7 days. No readmission happened within 30 days. All patients underwent lymph node sampling or dissection with 2–9 (5.69±1.46) groups and 3–21 (9.80±3.43) lymph nodes harvested. Total intraoperative cost was 60 389.66–134 401.65 (93 809.23±13 371.26) yuan. Conclusion Robot-assisted pulmonary lobectomy is safe and effective in treating p-Stage Ⅰ NSCLC, and could be an important supplement to conventional VATS. Regarding to cost, it is relatively more expensive compared with conventional VATS. RATS will be widely used and make a great change in pulmonary surgery with the progressive development of surgical robot.
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Reportamos un caso de secuestro pulmonar intralobar ubicado en el lóbulo inferior del pulmón izquierdo en una paciente de sexo femenino de 3 años de edad, diagnosticado en el intraoperatorio. El secuestro pulmonar es una malformación pulmonar congénita muy rara, caracterizada por una masa de tejido pulmonar no funcionante,que recibe irrigación anómala de una arteria sistémica, generalmente, procedente de la aorta descendente; su variedad intralobar usualmente se manifiesta con neumonías recurrentes. El diagnóstico definitivo es hecho al identificar la arteria anómala hacia el pulmón mediante estudios por imágenes (TEM con contraste y ecografía Doppler).No hay estudios de su incidencia a nivel nacional. El presente caso es el primero reportado en la ciudad de Huacho, Perú
The case of a 3 year-old female patient, who was intraoperative diagnosed with intralobar pulmonary sequestration located in the lower lobe of the left lung, is reported. Pulmonary sequestration is a rarecongenital pulmonary malformation characterized by a non-functionalmass of lung tissue, which is irrigatedby an abnormalsystemic artery, general!y originated in the descending aorta;its intralobar variety manifests as recurrent pneumonia. Definitive diagnosis is made after identifying the abnormal artery with imaging techniques (MSCT with contrast and Doppler echocardiography). There is no national incidence study on this condition. The following case is the first pulmonary sequestration case reported in the city of Huacho, Perú
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Objective To evaluate Effects of general anesthesia combined with thoracic paraver-tebral block(TPVB)on postoperative recovery after thoracoscopic pulmonary lobectomy. Methods Eighty patients were randomized into the general anesthesia group( G group)and general anesthesia combined TPVB group(GT group). Under the guidance of ultrasound,patients in the GT group received 20ml of 0. 5% ropivacaine for TPVB,and sevoflurane and propofol for combined anesthesia. Patients in the G group received sevoflurane,propofol and remifentanil for combined anesthesia. Extubation time,postoperative vis-ual analogue scale(VAS),quality of recovery(QoR)score,and adverse reaction were all recorded. Results Patients in the GT group had less extubation time and earlier ambulation time compared to the G group. Postoperatively,at the 1st,24th and 48th hour,patients in the G group had significantly higher VAS values both at rest and on movement than GT group(P < 0. 05). The opioid consumptions in GT group were lower than the G group(P < 0. 05). The QoR values of GT group at 24th and 48th hour[(152 ± 21)min and (175 ± 17)min]were significantly higher than the G group[(134 ± 25)min and(162 ± 20)min]respec-tively. There were significant differences in hospitalization expenses,the hospitalization stay and the inci-dence of complications between the two groups. Conclusion The ultrasound-guided paravertebral block can improve the quality of recovery in patients undergoing thoracoscopic pulmonary lobectomy.
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Objective To discuss if the intraoperative releasing inferior pulmonary ligament would affect the postoperative compensatory dilation of the residual lung in the patients going through the resection of the upper lobe under the thoracoscope. MethodFrom January 2010 to June 2014, 100 patients with lung cancer of right upper lobe were undergone resection of the upper lobe under thoracoscope in our department. They were randomly divided into two groups, the experimental group(the non-released group) with 50 people who were not released inferior pulmonary ligament during resection of the right upper lobe under thoracoscope. The control group(the released group) with 50 people who were released inferior pulmonary ligament during resection of the right upper lobe under thoracoscope. Observed the amount of daily thoracic cavity drainage, total drainage, the average extubation time and length of stay after the operation. Results Statistically compare postoperative residual cavity fluid level reserved rate of two groups of patients.There does not exist significant difference (P > 0.05) and the average drainage on the chest also is not significant (P > 0.05). Besides, there does not exist significant difference (P > 0.05) in the average time of decannulation of chest drainage tube, pleural biopsy cases and times, and postoperative hospital stay between two groups either. ConclusionIt’s unnecessary to release the inferior pulmonary ligament during resection of the right upper lobe under thoracoscope, which will not affect postoperative recovery and prolong length of hospital stay. Therefore it’s suitable for clinical promotion.
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OBJECTIVE: The aim was to evaluate the feasibility and safety of early chest tube removal after complete video‑assisted thoracic lobectomy (CVATL). METHODS: Retrospective analysis was performed on effects of chest tube removal on patients with lung cancer after pulmonary lobectomy between November 2013 and October 2014. 154 eligible patients included 97 cases for CVATL and 57 cases for open thoracic lobectomy. Patients with CVATL were divided randomly into experimental group (EG) and control group (CG), in which 51 patients in EG had chest tube removal on the 2nd day after operation; 46 patients in CG had the tube removal when the drainage volume <100 ml/day. Patients in open thoracic lobectomy group (OG) had the tubes removal as CG. The drainage volumes of the 1st and 2nd 24 h after operation, duration of chest tubes, cases of pain alleviation, and recurrent pleural effusions requiring reintervention were measured. RESULTS: The average drainage volume of the 1st 24 h after operation of CVATL group from EG and CG was significantly reduced than that in OG (260.41 ml vs. 353.16 ml, P < 0.001). The average drainage volume of the 2nd 24 h after operation of CG was significantly reduced than that in OG (163.91 ml vs. 222.98 ml, P < 0.001). The average duration of chest tube of CG for 2.98 days showed significant different compared with OG for 3.81 days (P < 0.001). Chest tube removal in CVATL group increased more chest pain alleviation than OG (80.4% vs. 56.1%, P = 0.001). The frequencies of recurrent pleural effusions requiring reintervention were 5.88% (3/51), 4.35% (2/46) and 5.26% (3/57), respectively, which had no significant differences between three groups (P = 1.000). CONCLUSIONS: Complete video‑assisted thoracic lobectomy brings less drainage volume after operation. Early removal of chest tube in CVATL shows feasible and safe and demonstrates that it may reduce postoperative pain and help fast recovery.
Subject(s)
Adult , Aged , Chest Tubes/therapeutic use , Female , Feasibility Studies , Humans , Male , Middle Aged , Lung Neoplasms/surgery , Pneumonectomy/methods , Thoracic Surgery, Video-Assisted/methodsABSTRACT
Objective To study the effect of electrical stimulation breath training on lung function of patients following pulmonary lobectomy. Methods 62 patients following pulmonary lobectomy were randomly allocated into experimental group (n=30 )and control group (n=32). The experimental group received a 4-week supervised electrical stimulation breath training program using an electric stimulus feedback trainer (20mins per time, 3 times per week);The control group received postoperative routine nursing. Cadiopulmonary function evaluation of 2 groups were tested before and after the experiment. The evaluation included the 6-min walking test (6MWD), FVC, FEV1,W,AT and VO2max/kg. Results After 4 week training, the value of 6MWD,W,FVC,FEV1 all improved, compared to the baseline value (P < 0.05) and the value of 6MWD,W,FVC,FEV1 were more obvious in experimental group, compared to control group(P<0.05). The AT value and the VO2max/kg value increased than the baseline value (P<0.05)and the improvement degree was more remarkable in experimental group than that in control group (P<0.05). Conclusion Electrical stimulation breath training can improve cardiopulmonary function of the patients following pulmonary lobectomy.
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Objective To investigate the results and effects of freezing phrenic nerves for the patients of pulmonary lobectomy.To optimize the best freezing time by studying the effects of different time at-65 ℃.Methods 50 patients of pulmonary lobectomy were randomly entered into 5 groups,including control group,30 seconds group,60 seconds group,90 seconds group,120 seconds group.After operation,the patients' cardiotach,blood pressure,SaO2,breath rate,time period of pulling out drainage tube and VAS about referred pain of scapular region were noted.After pulling out the intrathoracic drain tube,the routine chest normal X ray film and chest ultrasonic inspection were processed and the post-operation remnant cavity were observed.The chest normal fluoroscopy was inspected in 90 days after operation in order to observe the motion information of trouble side diaphragmatic muscle.Results The chest fluid [first day (329±178) ml,(345±150)ml,(268±51) ml,(227±36) ml,second day (251±131) ml,(269±112) ml,(208±61) ml,(158±110) ml,time of pulling out intrathoracic drain tube (5.8±1.75) days,(4.6±1.77) days,(3.9±0.74) days,(3.6±1.07) days] and VAS [(3.6±2.9) scores,(2.2±2.4) scores,(1.0±1.3) scores,(0.7±1.2) scores] about referred pain of scapular region of freezing groups were obviously lower than those in the control group [(375±136) ml,(309±132) ml,(5.7±2.36) days,(4.0±3.3) scores].90 s and 120 s freezing groups were lower than that of 30 s and 60 s groups,andthe 90 s freezing group did not significantly different from the 120 s group.The heart rate,blood pressure,saturation of blood oxygen and breathing rate of each group also had no difference.The remnant cavity sizes were larger in the control group (＞200 ml),they also had more fluidity (＞200 ml),and one case had been taken punctuation.The remnant cavity sizes of freezing groups were small and didn' t need special treatment.The diaphragmatic muscle' s movement of each group were fine after 3 months of operation.Conclusion The freezing phrenic nerves can effectively reduce the chest fluid,the post-operation remnant cavity and the time of pulling out intrathoracic drain tube.The freezing phrenic nerves can reduce the pain of referred pain of scapular region.The best freezing time should be 90 s.The freezing phrenic nerves do not influence the respiration function,and should be advantages of for the clinic researches and applications.
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Introducción: el acceso videotoracoscópico, para la resección del cáncer de pulmón, constituye una alternativa a la cirugía abierta en los estadios I y II de la enfermedad. Objetivo: valorar la aplicación de esta técnica en nuestro medio, y para ello se estudiaron las variables: localización del tumor, tiempo quirúrgico, la conversión a cirugía abierta, sangrado, tipo de resección, tamaño de la incisión, estadía hospitalaria, morbilidad y mortalidad. Métodos: se realizó un estudio descriptivo de los pacientes con carcinoma de pulmón atendidos en el hospital "Hermanos Ameijeiras" en el período comprendido entre octubre de 2009 y marzo de 2010, y entre enero-febrero de 2011, en el que se analizaron 5 pacientes que tenían tumores malignos de 5 cm o menos, de localización periférica, pero sin infiltración de la pared torácica, que no tuvieron enfermedad mediastinal o del hilio pulmonar, y sin cirugía previa del hemitórax afectado. Los resultados se presentaron en por cientos. Resultados: a 4 se les realizó una lobectomía pulmonar y a 1 una bilobectomía media e inferior. El tiempo quirúrgico varió de 210 a 420 min, con mediana de 330. No hubo conversión ni accidente quirúrgico. El tamaño de la incisión varió de 2,5 a 3,8 cm, con una mediana de 3,5. Un paciente con adenocarcinoma bronquioloalveolar y ganglios mediastinales positivos falleció a los 4 meses por enfermedad metastásica. Conclusiones: la resección pulmonar videotoracoscópica, por cáncer de pulmón, es factible y de gran beneficio inmediato para el enfermo en nuestro medio
Introduction: the video-thoracoscopic access to resection of lung cancer is an alternative for the open surgery for a disease in I and II stages. Objective: to value the implementation of this technique in our environment and thus, authors studied the following variables: tumor location, surgical time, open surgery conversion, bleeding, type of resection, incision size, hospital stay, morbility and mortality. Methods: a descriptive study was conducted in patients presenting with lung carcinoma, seen in the "Hermanos Ameijeiras" Clinical Surgical Hospital from October, 2009 to March, 2010 and from January-February, 2011 to analyze the situation of 5 patients with 5 cm or less malignant tumors of peripheral location but without infiltration of the thoracic wall, mediastinal or hilum-pulmonary disease and also without a previous surgery of the involved hemithorax. Results: four patients underwent a pulmonary lobectomy and another one a middle and inferior bi-lobectomy. The surgical time fluctuates between 210 and 420 min, with a mean of 330. There was neither conversion nor surgical accident. The incision size varied from 2.5 to 3.8 cm with a mean of 3.5. A patient with bronchoalveolar adenocarcinoma and positive mediastinal ganglia deceased at 4 months due metastatic disease. Conclusions: the video-thoracoscopic pulmonary resection from pulmonary cancer is feasible and of a immediate benefit for the patient in our environment
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Video-Assisted Surgery/methods , Lung Neoplasms/surgery , Pneumonectomy/methodsABSTRACT
Objective To compare clinical effects of mini-incision pulmonary lobectomy with or without thoracoscopic assistance. Methods A total of 64 patients, in order of precedence of the operation, were divided into two groups according to a random numbers table. The Group A was given thoracoscopy-assisted mini-incision pulmonary lobectomy while the Group B underwent simple mini-incision lobectomy. Results The length of incision was significantly shorter in the Group A (5.3?0.6 cm) than in the Group B (8.9?0.5 cm) (t=-24.360,P=0.000); the intraoperative blood loss in the Group A (279.7?74.0 ml) was significantly less than that in the Group B (331.7?42.5 ml) (t=-3.330,P=0.002); the drainage volume at the first postoperative day was remarkably less in the Group A (162.5?47.4 ml) than in the Group B (202.0?49.2 ml) (t=-3.220,P=0.002). Complications were noted in 5 patients in the Group A and 11 patients in the Group B (?~2=4.099,P=0.043). The Group A presented a significantly shorter postoperative hospital stay (8.0?2.2 d) than the Group B (9.7?1.9 d) (t=-3.280,P=0.002). There was no statistically significant difference in the operating time between the two groups (t=-1.130,P=0.262). A follow-up observation was carried out in 57 patients for 6~12 months. Local recurrence was observed in 1 patient with stage Ⅲa lung squamous carcinoma at 6 months after operation in the Group A, whereas in the Group B, distant metastasis with local recurrence was found in 2 patients with stage Ⅲa small-cell lung carcinoma and in 1 patient with lung adenocarcinoma at 7~8 months after surgery. All the 4 patients died within 1 year. Three patients ended with other diseases unassociated with the surgery. No local recurrence or distant metastasis was found in the remaining 50 patients. Conclusions As compared with simple mini-incision pulmonary lobectomy, thoracoscopy-assisted mini-incision procedure provides less surgical invasion, fewer complications, and quicker postoperative recovery.
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The serious complications of pulmonary arteriovenous malformation (PAVM) are hypoxia, dyspnea, hemothorax, cerebrovascular accident, and brain abscess due to an intrapulmonary right to left shunt. We report no anesthetic complications intraoperatively or postoperatively in a 40-year-old male with PAVM who underwent brain abscess removal and pulmonary lobectomy without specific invasive monitoring.
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Adult , Humans , Male , Hypoxia , Arteriovenous Malformations , Brain Abscess , Brain , Dyspnea , Hemothorax , StrokeABSTRACT
We present a minimal invasive technique for the treatment of broncho-pleural fistula (BPF) after pulmonary lobectomy with lung cancer. 2 cases of BPF were found at the 4th and 7th day after pulmonary lobectomy respectively. They were reoperated on by VATS, direct resuture of stump and consolidation with acrylic or fibrin glue. Both cases were cured. Authors consider mentioned procedure might be a feasible therapeutic approach for early broncho-pleural fistula.